LIBRARY OF CONGRESS. 

' Shelf. Alt 



UNITED STATES OF AMERICA. 



\y 



TH E 



MODERN THERAPEUTIC 



SERIES. 



I. MODERN MEDICAL THERAPEUTICS : A Compendium 

of Recent Formulae and Specific Therapeutical Directions, from 
the Practice of Eminent Contemporary Physicians, American 
and Foreign. By George H. Napheys, A. M., M. D., etc. 
Seventh Edition, enlarged and revised to 1880. 1 vol. 8 vo 
Pp. 608. Price, cloth, $4.00 ; sheep, $5 00. 

II. MODERN SURGICAL THERAPEUTICS: A Compendium 

of Current Formulae, Approved Dressings, and Specific Meth- 
ods for the Treatment of Surgical Diseases and Injuries. By 
George H. Napheys, A. M., M. D., etc. Sixth Edition, 1879 
1 vol. 8 vo. Pp. 601. Price, cloth, $4.00 : sheep, $5.00. 

III. THE THERAPEUTICS OE GYNECOLOGY AND OB- 

STE 1 RICS : Comprising the Medical, Dietetic, and Hygienic 
Treatment of Diseases of Women, as set forth by distin- 
guished contemporary specialists. Edited by Wm. B. Atkin- 
son, A. M., M. D., etc. 1 vol. 8 vo. Pp. 370. Price, 
cloth, $3 00; sheep, $3 50. 



*j* Any of the above works sent by mail, post-paid, on receipt of 
the price, by the publisher. 

D. G BRINTON, 
115 South 7TH Street, Philadelphia. 



THE 



THERAPEUTICS 



OF 



Gynecology «■■> Obstetrics 

COMPRISING THE 

Medical, Dietetic, and Hygienic Treatment 



OF 



Diseases of Women, 



AS SET FORTH 

BY DISTINGUISHED CONTEMPORARY SPECIALISTS. 



'edited by 

WILLIAM £ ATKINSON, A. M , M. D., 

< i 

AUTHOR OF " HINTS IN THE OBSTETRIC PROCEDURE," LECTURER ON DISEASES OF 
CHILDREN AT THE JEFFERSON MEDICAL COLLEGE, PHYSICIAN TO THE DE- 
PARTMENT OF OBSTETRICS AND DISEASES OF WOMEN, HOWARD 
HOSPITAL; CORRESPONDING MEMBER OF THE GYNECOLOG- 
ICAL SOCIETY, BOSTON; FELLOW OF THE AMERICAN 
ACADEMY OF MEDICINE; HONORARY MEMBER 
OF THE MEDICO-CHIRURGICAL SOCI- 
ETY, BOLOGNA, ITALY; ETC., ETC. 







PHILADELPHIA : 
D. G. BRINTON, 115 SOUTH SEVENTH STREET. 
1880. 



9r 




• An 



Entered according to Act of Congress/in the year 1880, by 

D. G. BRINTON, 

In the Office of the Librarian of Congress. 

All rights reserved. 



FROM THE PRESS OF THE 

INQUIRER P. & P. CO., 

LANCASTER, PA. 



PUBLISHER'S NOTICE 



The present volume is the third in the Series of" Modern Ther- 
apeutics," originally projected by the late Dr. George H. Naph- 
eys, but which his deatth prevented him from completing. The 
work has been finished under the able supervision of Dr. Wm. B. 
Atkinson, whose wide experience in this branch of professional 
study is a sufficient guarantee that it has been well done. 

The aim of the Series is to present the most modern and ap- 
proved plans of treating the diseases considered, as set forth by 
the most eminent authorities, and specialists in this country and 
Europe. The word Therapeutics is taken in its widest sense, in- 
cluding all efficient means of combatting disease, not only phar- 
macal, but hygienic, dietetic, climatic and specific as well. A 
number of authors are quoted, and their views accurately pre- 
sented. When they differ, as is not infrequently the case, no ma- 
gisterial attempt is made to decide which is in the right, as this 
difference of opinion is evidence that further, observation and a 
very wide induction are demanded to reach a positive decision. 
It is better that such difference should be noted by practitioners, 
and that the circumstances of the case and its surroundings should 
be the guide to the selection of remedial measures. 

The " Resumes of Remedies," added to each disease, are in- 
tended to set forth, in alphabetical order, all the agents which have 
been recommended in its treatment by good, recent authorities. 
New methods and recent additions to the Materia Medica are given 
special attention, but only such admitted as appear to have solid 
evidence in their favor. Those of special value are marked with 
an asterisk (*). In this department recent medical periodical liter- 

(v) 



yi PUBLISHER S NOTICE. 

ature has been closely scanned for information, and references are 
given to special articles and monographs. 

Substantially the same plan is carried out in all the volumes of 
the series, and the favorable .reception which the Medical Thera- 
peutics and the Surgical Therapeutics have met with, induces a 
hope that the present volume will be found not less serviceable 
to the practicing physician. 



EDITOR'S PREFACE 



In compliance with the wish of the publisher, the editor of the 
present volume has carefully reviewed the material prepared for it 
and has added extensively from recent treatises, monographs, and 
journals, containing matter on the two specialties represented. 
The great activity which has been manifested of recent years in 
these branches, particularly that of Gynecology, renders it almost 
impossible for a physician who has to attend to a large general 
practice to follow the rapid advance in therapeutic methods which 
has taken place. This work is designed to present him all of these 
which are worth his attention ; great care has been exercised that 
nothing of ascertained value should be omitted ; and the editor 
believes that very few omissions of this character will be found. 

In accordance with the plan preferred by the publisher, precise 
directions in the plans of treatment have been preserved, and the 
exact formulae presented whenever these could be obtained. 
Undoubtedly, in some instances, the therapeutic vagueness which 
is fashionable in many books on practice at the present day, is 
largely chargeable with the distrust of remedial measures often 
encountered among medical men. 

It has been deemed best to preface each chapter with a "Syn- 
opsis of Diagnostic Points," setting forth, in brief but clear forms, 
the distinctive signs and symptoms between the diseases consid- 
ered in the chapter. This permits the etiological plans of treat- 
ment to be presented more distinctly, and may also serve as a 
reminder in cases of puzzling similarity. 

Philadelplda, 1880. 

(vii) 



TABLE OF CONTENTS 



PAGE. 

Publisher's Notice 5 

Editor's Preface 7 

Table of Contents 9 



PART I. 
GYNECOLOGICAL THERAPEUTICS. 



CHAPTER I. 

DISEASES OF THE OVARIES, DISORDERS OF MENSTRUATION, 
AND GENERAL DISEASES. 

Synopsis of Diagnostic Points 17 

Ovaritis. 17 

Ovarian Tumors 18 

Amenorrhea 21 

Dysmenorrhea 22 

Menorrhagia and Metrorrhagia 23 

Chlorosis and Anemia 24 

The Change of Life 24 

Ovaritis (Acute, Subacute and Chronic ) 26 

Ovarian Neuralgia 27 

O varian Dyspepsia 28 

Ovarian Hyperemia 29 

Acute and Chronic Ovaritis 29 

Resume of Remedies 30 

General Methods 30 

Ovarian Tumors 31 

Internal Medication 31 

Injections into the Sac 3 ; 

Electrolysis 32 

Amenorrhea 33 

Menstruation is and always has been absent 33 

Menstruation is scanty or irregular 33 

Suppression of the Menses 34 



X TABLE OF CONTENTS. 

PAGE. 

Chronic Suppression 34 

Plethoric Amenorrhea 37 

Nervous Amenorrhea 37 

Tuberculous and Scrofulous Amenorrhea 37 

Amenorrhea by Counter Fluxion 37 

Amenorrhea from Anemia and Chlorosis 39 

Resume of Remedies 41 

General Measures 44 

Dysmenorrhea 46 

Neuralgic Dysmenorrhea 46 

Congestive Dysmenorrhea 46 

Obstructive Dysmenorrhea 46 

Membranous Dysmenorrhea 46 

Ovarian Dysmenorrhea 47 

Neuralgia of the Uterine Neck 49 

Spasmodic Dysmenorrhea 49 

- Dysmenorrhea from General Causes 49 

Dysmenorrhea through Insufficiency 50 

Menorrhagic Dysmenorrhea 50 

Irregular Dysmenorrhea 50 

Rheumatic Dysmenorrhea 52 

Membranous Dysmenorrhea 54 

Resume of Remedies , 55 

Mechanical Remedies ... - 57 

Menorrhagia and Metrorrhagia 59 

Passive Hemorrhage 59 

Resume of Remedies 65 

Vaginal Injections 70 

Hysteria 71 

Resume of Remedies 74 

External Remedies . . . . 76 

Chlorosis 77 

Resume of Remedies 79 

The Climacteric Epoch, or the Change of Fife 81 

Resume of Remedies 83 



CHAPTER II. 

DISEASES OF THE UTERUS AND ITS ANNEXES. 

Synopsis of Diagnostic Points 85 

General Observations 85 

Uterine Symptoms 86 

Uterine Inflammations 87 

Metritis and Cervicitis 88 

Endometritis and Endocervicitis 89 



TABLE OF CONTENTS. XI 

PAGE. 

Metritis (Non-puerperal, Endo , Peri-, Para-Metritis, Uterine Catarrh, 

etc.) 97 

General Treatment 90 

Local Treatment 91 

Chronic Endometritis 92 

Chronic Metritis 96 

Acute Endometritis 96 

Parametritis 96 

Perimetritis 96 

Pressure in Uterine Diseases . . 97 

Intra- uterine Medication 98 

Uterine Injections . . . , 98 

Medicated Injections 99 

Pledgets (Pinceaux) . . .V, 101 

Crayons or Pencils 102 

Ointments and Glyceroles 102 

Capsules 1 03 

Powders 103 

Pessaries or Intra-uterine Tents 103 

Resume of Remedies 103 



External Measures 



[04 



Cervicitis (Ulceration and Granulation of the Os, etc.) 105 

Indolent Ulcers 105 

Inflamed Ulcers 105 

Fungous Ulcers 105 

Senile Ulcers 105 

Diphtheritic Ulcers 105 

Caustics 107 

Ignipuncture 108 

Interstitial Injection 112 

Mechanical Treatment 115 

Tents for Dilating the Cervix 116 

Resume of Remedies 117 

Uterine Tents 119 

Other Measures 121 

Displacements 122 

Retroversion and Anteversion 123 

Anteflexion 125 

Prolapsus of the Uterus 125 

Inversion of the Uterus 126 

Pessaries , 126 

Flexures of the Uterus 129 

Procidentia 130 

Chronic Inversion of the Uterus \ 130 

Rules for the Use of Pessaries , 131 

Non-Malignant Growths 137 

Polypi 137 

Fibrous Growths 139 



Xll TABLE OF CONTENTS. 

PAGE. 

The Medical Treatment of Uterine Tumors 142 

Resume of Remedies 145 

Other Measures 147 

Maltgnant Growths 148 

Cancer , 148 

Epithelial Cancer 150 

Sterility and Anaphrodisia 152 

Nymphomania 155 

Resume of Remedies 155 



CHAPTER III. 

DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

Synopsis of Diagnostic Points 157 

Vaginitis 157 

Cystitis 158 

Urinary Disorders 158 

Vaginitis, Acute and Chronic — Vaginal Catarrh — Leucorrhea — Col- 
pitis 1 60 

Vaginal Injections. . ,' 160 

Vaginal Irrigations 160 

Medicated Tampons 161 

Vaginal Cataplasms 161 

Vaginal Suppositories 161 

Resume of Remedies 167 

Vaginal Injections „ 168 

Vaginitis (Specific, Gonorrheal) 172 

Gonorrheal Cervicitis 174 

Gonorrheal Acute Ovaritis '. j 74 

Gonorrheal Metritis 1 74 

Vaginismus and Dyspareunia 176 

Resume of Remedies 178 

Vaginal Growths 179 

Caruncle of the Urethra 179 

Non-Syphilitic Warts 179 

Vegetations, flat and horny 1 80 

Pruritis Vulv^ seu Vaginae, and Vulvitis 181 

Eczema Genitale 182 

Resume of Remedies 184 

Cystitis 187 

Urethritis 190 

Catarrhal Urethritis 1 90 

Urinary Disorders— Irritable Bladder, Dysuria, Polyuria, Ischuria, etc. 192 

Vascular Growths 193 

Irritable Bladder 194 

Incontinence of Urine 194 



TABLE OF CONTENTS. Xlll 



PART II. 

OBSTETRICAL THERAPEUTICS. 



CHAPTER I. 

THE DISORDERS OF PREGNANCY. 

PAGE. 

Thf. Hygiene of the Puerferal State 197 

P'ood 198 

Clothing 198 

Exercise . . . . 198 

Sleep s 198 

Mental Condition 199 

Marital Relations 199 

Abortion and Premature Labor 200 

Induction of Premature Labor 206 

Resume of Remedies , 211 

Uterine Sedatives and Tonics. . .' ' 211 

Ecbolic and Abortifacient Agents 212 

Vomiting and Nausea of Pregnancy 214 

Resume of Remedies , 217 

Internal Remedies 217 

Local Measures 219 

Sympathetic Nervous Disorders 221 

Palpitation 221 

Syncope 221 

Neuralgia 221 

Headaches ... 221 

Insomnia 222 

Hypochondriasis 222 

Nervous Cough 222 

Pruritus 223 

Digestive Derangements of Pregnancy 225 

Gingivitis, Puerperal Salivation 225 

Diarrhoea 226 

Constipation 226 

Hemorrhoids '. . 226 

Albuminuria of Pregnancy 228 

Resume of Remedies 232 

CHAPTER II. 

COMPLICATIONS, DISORDERS AND SEQUELAE OF PARTURITION. 

AN/Esthetics in Labor 233 

Conclusions on 235 



XIV TABLE OF CONTENTS. 

PAGE. 

Propositions on 237 

Resume of Remedies 238 

Tedious Labor 

Rigid Os and Atony of Uterus 239 

Feeble or Irregular Action 242 

Excessive Distension of the Uterus 242 

Resume of Remedies 244 

External Measures 246 

After Pains 248 

Resume of Remedies 249 

Puerperal Hemorrhage 250 

Resume of Remedies 260 

General Measures 261 

Puerperal Eclampsia 264 

Resume of Remedies 269 

General Measures , 270 

Puerperal Mania 271 

Puerperal Fever (Puerperal Septicemia, Puerperal Pyemia) 276 

Excessive and Septic Lochial Dischar<*% 276 

Septicemia 279 

Antiseptic Management of Labor . 280 

Resume of Remedies 287 

General Remedies 288 

Puerperal Thrombosis and Embolism 289 

Puerperal Shock 29 1 

Pelvic Cellulitis and Peritonitis (Puerperal Phlebitis and Metritis). . 292 

Diagnostic Points , 292 

Treatment 292 

Puerperal Metritis 295 

Puerperal Peritonitis . . „ , 297 

Resume of Remedies 300 

Other Measures 301 

Phlegmasia Dolens 303 

Mllk Fever 304 

Puerperal Convalescence 306 

Retarded Involution 307 

Laxatives for Puerperal Women 307 



CHAPTER III. 

DISEASES OF THE MAMMARY GLANDS AND OF LACTATION. 

Mastitis and Mammary Abscess 309 

Antiseptic Method of Opening an Abscess 311 

Resume of Remedies 318 

General Measures 319 






TABLE OF CONTENTS. XV 

PAGE. 

Mammary Tumors 321 

Diagnostic Points 321 

Adenoma, Sarcoma, Scirrhus 321 

Encephaloid Cancer, Benign Cystic Growth 322 

Hysterical Breast 322 

Treatment 322 

Mammary Hypertrophy 323 

Milk Tumors 323 

Serous Cysts 323 

Hydatid Tumor 324 

Fibroid and Adenoid Tumors 324 

Carcinoma 324 

Caustic Arrows 325 

Mammary Neuralgia (Mastodynia) 326 

Galactorrhea 327 

Resume of Remedies 330 

Agalactia and Oligogalactia ^32 

Means to Increase the Milk 332 

Means to Re-establish Lactation 332 

To Prevent Accidents from Sudden Cessation 332 

Galactagogues , . 334 

Food as a Remedy 3 3 e 

Resume of Remedies , -^6 

Diseases of the Nipples ^"j 

Resume of Remedies -34c 



PART I 



GYNECOLOGICAL 

THEEAPEUTICS. 



CHAPTER I. 

DISEASES OF THE OVARIES, DISORDERS OF 
MENSTRUATION, AND GENERAL DISEASES. 

Synopsis of Diagnostic Points — Ovaritis, Acute and Chronic {Ovar- 
ian Neuralgia, etc) — Ovarian Tumors — Amenorrhea — Dysmen- 
orrhea — Menorrhagia and Metrorrhagia — Hysteria — Chlorosis 
and Anemia — The Change of Life, or Climacteric Epoch. 

SYNOPSIS OF DIAGNOSTIC POINTS. 

OVARITIS. 

The principal diseases of the ovaries are acute, subacute, and 
chronic ovaritis or oophoritis, and ovarian tumors. 

The following are the distinctions between the two forms of 
inflammation of the organ. 



Acute Ovaritis. 
Preceded by sudden suppression 
of menstruation, gonorrhea, pelvic 
peritonitis or external violence. 



Chronic Ovaritis. 
Preceded by displacements of 
uterus, irregular menstruation, or 
neglect of precautions at menstrual 
epoch. 
(.17) 



18 



DISEASES OF THE OVARIES. 



Fever, perhaps chill ; severe pain 
in one or both iliac fossae. Great 
sensitiveness over the ovary, which 
may sometimes be felt as a round 
ball. 

Abscess or resolution in four to 
six days. 

The disease is rare. 



Fixed pain over one or both 
ovaries, dysmenorrhea and hysteria, 
pain in rectum and down thighs, 
worse after defecation, leucorrhea, 
sometimes sterility and dyspareunia. 

Chronic, and not amenable to 
treatment. 



The disease is quite common. 

In the subacute form, by the recto-vaginal touch, we may grasp 
with the two fingers a smooth, roundish body, as large as a 
cherry, producing exquisite pain. This sign is characteristic of 
subacute oophoritis, for neither simple morbid congestion of the 
ovary, nor oophoralgia, nor retro-uterine hematocele, nor metritis, 
nor lymphadenitis, nor perimetric phlegmon, will give the phenom- 
enon of pain so well marked and so precisely localized. 

It should be remembered that gonorrheal infection is an occa- 
sional cause of acute ovaritis, in which case specific treatment is 
demanded after the first symptoms have abated. 

In chronic ovaritis Atthill has observed that persistent vomit- 
ing was a prominent symptom. 

In a lecture reported in the London Medical Times and Gazette, 
Dr. J. Matthews Duncan states that occasionally this disease is 
seen as a consequence of fever, especially typhoid, cholera, rheum- 
atism ; and, in close connection with these diseases, it is very fre- 
quently a result of the use of alcoholic liquors, even when these 
are not taken to excess ; and this view of the causation of the dis- 
ease is in the most gratifying manner frequently corroborated, if 
not proved, by the cure which follows upon the adoption of strictly 
temperate living. A great mass of cases occur as a consequence 
of recent marriage, suppression of menstruation, abortion, and 
delivery at the full time, when there is no evidence of blood 
poisoning. 

OVARIAN TUMORS. 

The diagnosis of these tumors is often of the utmost difficulty. 
In the first place, pelvic tumors generally are simulated by preg- 
nancy, ascites, obesity, intestinal and vesical distention, and similar 
conditions. When a tumor is actually present, it may arise from 
other sub-peritoneal tissues as well as from the ovary. And when 
from the ovary, it may be either malignant or benign. 



SYNOPSIS OF DIAGNOSTIC POINTS. 19 

Professor Kceberle, of Strasburg, lays down the following gen- 
eral rules : 

In subperitoneal serous cysts, there is no loss of flesh. The 
tumor, unilocular, presents a very manifest fluctuation ; its walls 
are thin ; its development slow, though at times rapid enough ; it 
sometimes attains a considerable size without becoming adherent, 
to neighboring organs ; sometimes it is small and very adherent. 

In cysts of the ovary, wasting is pronounced. The tumor, 
whether uni- or multi-locular, often presents a limited fluctuation ; 
its walls are occasionally thin, occasionally more or less thick and 
resistant, hard and nodulated ; its development is ordinarily rapid, 
sometimes slow; lastly, it-is adherent whenever the volume is at 
all considerable. 

A more positive method is by aspiration and examining the con- 
tained fluid. This diagnosis rests principally on the presence or 
absence of albumen, metalbumen, and paralbumen. Parovarian 
cysts, or those of the broad ligament, contain a very fluid liquid, 
generally colorless and limpid as water, sometimes quite salt, but 
generally not containing any albuminous material ; when it does 
contain albumen, it is the paralbumen that is precipitated by nitric 
acid, but the precipitate redissolves in acetic acid. 

Cysts of the Fallopian tube contain only albumen, and no par- 
albumen ; the. precipitate produced by nitric acid is increased by 
acetic acid. 

Ovarian cysts furnish a liquid charged with albumen, metalbu- 
men, and especially paralbumen, giving a precipitate soluble in 
nitric acid. 

Well marked, these reactions are conclusive ; but there are ex- 
ceptional cases where they are but feebly present. 

All doubt is removed, however, and we have to do with an ova- 
rian cyst, when puncture gives exit to a glutinous fluid, sometimes 
entirely uncoagulable by heat and nitric acid, rarely limpid, con- 
taining only traces of albumen (colloid cysts), or a fatty liquid con- 
taining in suspension mucus and epidermic detritus or hair (der- 
moid cysts). Lastly, examined by the microscope, the fluid of 
ovarian cysts contains granular globules, yellowish, 0.003 milli- 
metres to 0.060 millimetres in diameter, the envelope being ren- 
dered more apparent by acetic or phosphoric acid. 

Mr. Spencer Wells remarks that in ascites, the stomach and 
intestines, containing air, float on the surface of the fluid, and, 



20 DISEASES OF THE OVARIES. 

therefore, the highest points of the tumor, the patient lying on her 
back, give out a clear sound on percussion. If, however, the fluid 
be contained in a cyst, the stomach and intestines are pushed 
aside, as the tumor rises in the abdomen, and lie in the epigastric 
and two lumbar regions. Hence, the highest points of an ovarian 
tumor emit a dull sound when percussed, and the epigastric and 
lumbar ones give a clear sound. By applying these general rules 
in any ordinary case, a few seconds will enable a surgeon to clear 
up all doubt. 

Atlee says mobility diminishes as size increases, there is free- 
dom from constitutional symptoms, the emaciation is most strik- 
ing about the face, neck, shoulders and arms, the expression of 
countenance is anxious, careworn, the features attenuated, the 
complexion pale. An important point is the position of the tumor 
in relation to the viscera; it is usually in front, and gradually 
crowds them backward, upward, and to the sides. There is a 
dull percussion sound over the space occupied by the* tumor. 
Fluctuation can be recognized only in the tumor. The form of 
the abdomen is rarely uniform. 

As a general rule, according to Dr. T. M. Drysdale, ovarian 
fluids have an animal odor ; they are rarely clear, usually cloudy, 
and frequently opaque ; in color they vary from that of white of egg 
or clear starch, to shades of yellow, red, green, or dark chocolate, 
or even inky black ; in consistence, they may be almost like water, 
or thin syrup, mucilage, oil, or molasses, or ropy, or jelly-like; 
but they always are sticky and viscid, and generally feel slimy. A 
sediment rarely fails to form after a few hours ; this is viscid, and 
often like pus. Reaction generally alkaline. Chemically they con- 
sist of albumen, fats, extractives and salts. Notably they contain 
an excessive amount of solid matter, often y\ of the whole weight 
of fluid. They never contain fibrin, unless hemorrhage has occurred 
into the cyst, or it has been inflamed. Microscopically they 
usually display free granular matter, oil globules, epithelial cells, 
crystals of cholesterine, etc., but no matter what other cells may be 
present or absent, the cell which is almost invariably found in ova- 
rian fluid is the granular cell. This is generally round or may 
be slightly oval, delicate, transparent, contains a number of fine 
granules, but no nucleus. The granules are well defined. Acetic 
acid makes them more distinct. Ether renders them nearly trans- 
parent. Other cells, on the addition of the acid, increase in size, 
become very transparent and exhibit nuclei. 



SYNOPSIS OF DIAGNOSTIC POINTS. 



21 



AMENORRHEA. 

Amenorrhea may be primitive or acquired. In the first form 
menstruation has never taken place, or if it has occurred at all, 
the discharge has always been scanty, or has appeared at pro- 
longed intervals, or both. In the second form menstruation has 
taken place regularly and healthily, and has afterwards become 
suppressed. 

The following table represents the various forms of this affec- 
tion, their causes and pathological significance : 



Menstruation 
absent 
(emansio 
mensium). 



Menstruation 
scanty. 

Menstruation f 
irregular 
and gen- 
e r a 1 1 y 
scanty. 



PRIMITIVE AMENORRHEA, 

Uterus undeveloped or absent ; 



No formation of 
decidua. 



Ovaries well 



Uterus well-de- 
veloped, but 
inactive. 

Ovaries, well- 
developed. 



c r f Uterus small. 

■ C rin y ,f *Ta\ °™ ies wel1 °r ill-developed, 
tion of decid- Uterus weUde _ . Anemi J 

veloped. \ Bad health. 

Uterus usually 

small, but! Anemia, 
may be well- j Bad health, 
developed. 



ill-developed, or absent. 

Anemia. 

Chronic disease. 

Bad hygienic conditions. 

Emotional shocks. 

Physical shocks. 

Acute diseases. 

Change of residence. 

Exposure. 

Bathing. 
[Plethora. (?) 



Irregular and 
generally 
scanty forma- < 
tion of decid 
ua. 



Menstruation 
absent 
(suppres-«j 
s i o men- 
sium). 



ACQUIRED OR SECONDARY AMENORRHEA. 

Anemia. 

Chronic disease of lung, 
liver, kidney, ovaries, 
uterus, or gastrointes- 
tinal canal. 
Uterus and ov- Bad hygiene. 

aries well- ^j Shocks, physical or emo- 
formed. tional. 

Acute diseases. 
Blood-taint. 
Exposure. 
Bathing. 

Change of residence. 
Over-involution after labor. 
Early menopause. 



No decid ua 
formed. 



In place of the discharge of blood, there may be a leucorrhea, 
more or less profuse. 



22 



DISEASES OF THE OVARIES. 



It should never be forgotten that in not infrequent instances 
amenorrhea, supervening apparently without cause, is the first 
sign of phthisis, and in all such cases should arouse the most 
active attention of the physician. Some writers hold that in these 
cases the amenorrhea is not so much the sign as the exciting 
cause of the tuberculous change. 

DYSMENORRHEA. 
The forms and causes of dysmenorrhea are defined by Prof. 
T. G. Thomas, in accordance with the following table : 



Form. 



Neuralgia. 



Dysmenorrhea. 



Congestive or In- 

flaramatory 
Dysmenorrhea. 

Obstructive Dys- 
menorrhea. 



Membranous 
Dysmenorrhea. 



Ovarian Dysmen- 
orrhea. 



Symptoms. 



Pain usually sharp and fixed. 



No expulsive pains ; flow steady ; 
no clots ; no obstruction ; occurs 
gradually ; is habitual ; no en- 
dometritis. 

Pain severe, sudden ; discharge 
lessens or ceases. General py- 
rexial signs, and inflammatory 
constitutional disturbance. 

Pain sudden and accompanied 
with an expulsive effort after 
menstruation has commenced 
some hours ("uterine colic"); 
recurrence of these symptoms. 
Discoverable obstruction. 

Pains steady, becoming violent 
and expulsive ; passage of 
membrane at each period ; as 
sequelae, endometritis and men- 
orrhagia. Very rare. 

Pain, dull and sickening, usually 
precedes the flow several days, 
and lessens when it comes on. 
Breasts painful or tender. 
" Submammary pain." " In- 
termenstrual pain," occurring 
between the epochs. Ovaries 
often enlarged and tender. 
Pain habitual at each epoch ; 
often shoots down the thigh. 



Causes. 



The neuralgic diathe- 
sis ; phethora or 
chlorosis ; malaria ; 
theumatoria ; onan- 
ism. 



Exposure to cold and 
wet ; tumors ; men- 
tal disturbance, en- 
dometritis, etc. 

Contraction of cervix ; 
uterine flexion ; pol- 
ypus or fibroid ; ob- 
turator hymen. 



Early abortions; diph- 
theritic endometri- 
tis. 



Ovaritis ; excessive 
nervous hyperass- 
thesia. 



Barnes says a characteristic sign of ovarian congestion is that 
the body of the uterus is drawn towards the affected ovary. 



SYNOPSIS OF DIAGNOSTIC POINTS. 23 

MENORRHAGIA AND METRORRHAGIA. 

By Menorrhagia is meant an excessive flow of blood at the men- 
strual period ; by metrorrhagia, a flow of blood between -the men- 
strual epochs. 

Neither of these forms of trouble can be called a disease, as 
they are solely symptoms of several kinds of uterine affection. 
In order to diagnose the cause, and thus obtain the indications for 
treatment, a careful examination becomes necessary. In most 
instances, it is the result of general debility, as from protracted 
nursing. Locally, it may be caused by the presence of tumors, 
as polypi, etc., affections of the os and cervix, congestion of the 
womb or ovaries, subinvolution of the womb, or inversion of that 
organ. 

Debility as a cause, is recognized by the usual symptoms, and 
the accompanying predisposing circumstances, as lactation, anx- 
iety, exhausting labor, etc. 

Polypi, when low down, are easily recognized by the finger, 
though the speculum may he used to confirm the diagnosis. In 
these cases there is leucorrhea, more or less bloody, and at inter- 
vals discharges of pure blood, without relation to the period of 
menstruation. Where a polypus is not found pendent in the 
vagina, the prsence of these growths may be suspected above, as 
in the canal of the neck, or even within the uterus itself, and at- 
tached to the fundus. The absence of other causes of the hem- 
orhage would demand dilatation of the organ if necessary, and a 
careful search for these excrescences. 

Subinvolution only occurs in women who have been pregnant 
Here, the womb, after delivery has been accomplished, fails to re- 
turn to its proper condition. The diagnosis is readily made by ex- 
amination. The uterus is much larger than natural, the os soft 
and patulous ; there are pains in the back, irritability of the blad- 
der, frequent micturition, with tenesmic efforts, and generally very 
profuse leucorrhea. These may end in erosion of the os and 
cervix, and added to these we may have congestion of the lips of 
the womb. 

Again, hemorrhage may be due to the presence of a portion of 
the placenta, which is frequently the case after an abortion. This 
might be suspected from the history of the case, and the diagnosis 
fully made by an exploration with the sound, when the foreign 



24 DISEASES OF THE OVARIES. 

body is detected. In such cases there is generally a certain 
amount of odor, as of a decaying body in the cavity. 

In the unmarried, a spongy state of the cervix is generally a 
cause ; this is shown by eversion of the lips, and granulations on 
the surface. 

Malignant disease as a cause is detected by the general history; 
there has been more or less pain, often lancinating, in the lower 
part of the abdomen, the back, around the hips, and extending 
down the thighs, which frequently seems to be much relieved 
after profuse hemorrhage has occurred. This hemorrhage would 
occur from a slight exertion, or after coitus. Examination shows 
in advanced cases fixation of the uterus, hardness and irregularity 
of the parts. In early cases, these symptoms all exist, but to a 
less extent. 

CHLOROSIS AND ANEMIA. 

These two diseases, though not strictly synonymous, may, from 
their great resemblance, be treated of as one. A marked feature 
is amenorrhea, or imperfect menstruation. The complexion is 
pale, or of a greenish yellow. The patient is listless, loses appe- 
tite, or only desires dainties, generally craves acids, or may even 
prefer articles of an injurious or loathsome nature; she is irritable, 
hysterical, suffers with headache, which is sure to come on after 
the slightest excitement or exertion. The poverty of the blood is 
shown by cold extremities, swelled feet and hands, puffiness of the 
face, dark rings around the eyes, and blowing sound of the heart. 
Though not always present, yet, in many instances, there are vague 
neuralgic stitches in the breasts, the head, the sacral region. In 
rare cases, after the disease has continued a while, a slow fever 
sets in, which may lead to an error in diagnosis. 

THE CHANGE OF LIFE. 
This period, known as the climacteric or menopause, varies 
greatly as to the time of its appearance. The woman menstruates 
for about thirty-five years, and then occurs a marked change, 
which may be sudden, or may slowly steal upon her. Most com- 
monly this is attended by a variety of troubles, which to a greater 
or less extent affect the general health. A most frequent symptom 
is irregularity of the menstrual function. It ceases, perhaps for 
months, and as suddenly reappears. Or the flow becomes alarm- 
ingly profuse, exhausting the patient, draining her. With this 



SYNOPSIS OF DIAGNOSTIC POINTS. 2$ 

may be associated hemorrhages from the nose, from the bowels, 
profuse leucorrhea, and brain symptoms as of congestion, vertigo, 
frequent syncope, epileptic or apoplectic seizures. Barnes regards 
the headache as peculiar, chiefly occipital, involving the nucha and 
spinal cord. The mind is affected. There are irritability, loss of 
memory, despondency, even partial insanity, but all of which are 
generally acknowledged by the patient, and she regrets her want 
of self-control. 

The appetite is capricious or lost, generally the bowels are obsti- 
nately costive, fat begins to accumulate, and these symptoms often 
give rise to the belief that the woman is pregnant, which is speedily 
dispelled by the proper examination. The liver and kidneys, in 
fact nearly every organ, are liable to become affected and to add to 
the general discomfort. 

Morbid growths are now extremely apt to present themselves, 
or when previously known, to take on increased action. In rare 
instances, a change for the better, a marked improvement occurs,, 
and an invalid is now restored to health, or at least greatly re- 
lieved. 



OVARITIS (ACUTE, SUB-ACUTE AND CHRONIC). 

PROFESSOR J. MATTHEWS DUNCAN, M. D., OF EDINBURGH. 

On the subject of acute and chronic ovaritis, this author states 
there is no specific treatment. In chronic cases, two, three or four 
leeches may be applied to the cervix uteri, through a speculum, 
after the monthly periods. Croton oil liniment, or antimonial lini- 
ment, or a blister, may be applied to the inguinal canal adjacent 
to the affected gland. The bowels should be regulated by gentle 
saline laxatives. Lcucorrhea, if present, should not be actively 
treated, but by mild injections only. Mercury and iodide of po- 
tassium may be given in small doses. 

PROF. GRAILY HEWITT, M. D., OF LONDON. 

In acute cases, entire rest is essential. When the attack is 
owing to a chill, from exposure, leeches should be applied over 
the ovaries, followed by hot anodyne poultices. Hot turpentine 
stupes are also valuable. 

In chronic cases, cold affusions and hip baths are often useful. 
Sexual indulgence must be strictly limited. At the menstrual 
periods, the patient should remain on the couch, and a stimulating 
nourishment be avoided. Between the epochs moderate out-door 
exercise is valuable, Tartar-emetic ointment or other counter- 
irritants may be used over the ovary. To relieve pain the follow- 
ing pill is efficacious : 

i. I£. Pulveris opii, gr.ss 

Extracti cannabis indicae, Z x -Yi> 

C amphorae, gr.j. M. 

For one pill, night and morning. 

EDWARD JOHN TILT, M. D., OF LONDON. 

In severe ovario-uterine pain, this practitioner recommends plac- 
ing a pledget of cotton-wool soaked in laudanum, or acetate of 
morphia, near or upon the neck of the womb. This may be re- 
peated daily or every other day. Two or three grains of morphia 
may be used at a time in this manner. 

When the ovaries are congested or inflamed, the best method of 
treatment is to leech the ivomb. Four leeches may be applied to 

(26) 



OVARITIS (ACUTE, SUB-ACUTE AND CHRONIC.) 27 

the cervix a day or two after the flow has ceased. The effect is 
usually well-marked. Blisters and ointments to the hypogastric 
region only act on the ovaries indirectly, and even double the 
number of leeches mentioned, when applied over the ovary, do 
not produce so permanent an effect. 

In chronic and obstinate forms of ovario-uterine disease, silk 
setons applied above the pubes, as recommended by Huguier, 
deserve trial. 

For the pelvic and spinal pains of ovario-uterine disease, Dr. 
Tilt recommends rubbing the surface twice a day with one of the 
following ointments : 

2. I£. Linimenti belladonnae, f.3ij 

Glycerinae amyli, f.Jj. M. 

3. $. Morphias acetatis, gr. x 

Glycerinae, f.5ss 

Otto rosarum, gtt.j 

Unguenti petrolei, 5j- M. 

4. I£. Potassii iodidi, 5j 

Magnesiae, gr.v 

Otto rosar., gtt.j 

Aquae, f-5j 

Unguenti petrolei, §j. M. 

Apply twice daily. 

5. I£. Atropiae sulphatis, gr.ij 

Morphiae sulphatis, gr.iv 

Olei olivae, f.3j 

Olei lavandulae, gtt.x 

Unguenti hydrargyri fortis, §j. M. 

A piece about the size of a small walnut is to be rubbed in morning 
and evening, over the sensitive ovary. 

LOMBE ATTHILL, M. D., DUBLIN, 

Finds great benefit from the inunction twice a day, over the part, 
of equal portions of the ointment of veratria and iodide of potas- 
sium, and in some cases he adds a small quantity of ointment of 
cantharides. 

. J. WARING CURRAN, M. D., LONDON. 

Ovarian Neuralgia. This writer maintains that in various in- 
stances we meet with true ovarian neuralgia, independent of any 
local lesion, and more remediable by constitutional than by local 
treatment. He identifies it with the ovarian irritation of Dr. 
Churchill. His prescription for such cases is : 



28 DISEASES OF THE OVARIES. 

6. I£. Ammoniae muriatis, 5ij 

Tincturae aconiti, f.3ij 

Syrupi aurantii corticis, f.^viij. M. 

A teaspoonful thrice daily in the treatment of ovarian neuralgia. 

Dr. Curran states that this combination has almost a magical 
influence in many cases. He reports [Medical Press and Circular, 
August 19th, 1868), six cases in which various sedatives and ano- 
dynes had been tried in vain. In all he found that before the 
above mixture was finished by the patient, the pains had entirely 
ceased. 

Dr. T. J. Newman, of Chicago, confirms the usefulness of this 
mixture, and records (in the Chicago Medical Examiner, for No- 
vember, 1869), three cases of neuralgia of the ovaries treated by it 
with success, after the failure of other remedies. 

In the same painful complaint, Dr. Roberts Bartholow has 
obtained excellent results from the following recipe : 

7. ]£. Extracti belladonnas, gr.iv 

Extracti stramonii, gr.v 

Extracti hyoscyami, gr.v 

Quiniae sulphatis, t)ij. M. 

Make twenty pills. One three times a day, in ovarian neuralgia and 
neuralgic dysmenorrhea. 

DR. J. MILNER FOTHERGILL, OF LONDON. 

Ovarian Dyspepsia. This writer has pointed out that a frequent 
complication and often the most prominent symptom, of subacute 
ovaritis is a form of gastric atony which he calls " ovarian dyspep- 
sia." [American Journal of Obstetrics, January, 1878.) For the 
treatment of such cases he recommends as the great therapeutic 
agent, the bromide of potassium. 

8. ty. Magnesiae sulphatis, 5j 

Potassii bromidi, 9j 

Infusi gentianas, f.fj. M. 

This amount three times a day, with an aloes and myrrh pill at bed 
time if necessary. 

A blister should be applied over the tender ovary. 

For the vaginal loss, injections of astringents in solutions by 
means of a Higginson's syringe, or the small india rubber ball and 
tube used to give babies enemata (much better in every way than 
a glass syringe), must be used twice a day, with hip baths daily, if 
the patient's condition will admit of it. This is far from unimpor- 



OVARITIS, (ACUTE, SUB-ACUTE AND CHRONIC.) 29 

tant. When there is menorrhagia, quietude and the avoidance of 
all warm drinks and food during the flow are desirable. For the 
imperfect digestion, light and easily digestible food, milk, if neces- 
sary, combined with an alkali, or beef-tea with a little cream in it, 
or custard, are indicated. Such food should be given at short in- 
tervals, and small quantities at once. The irritable stomach will 
often retain small quantities of food when larger amounts are at 
once rejected. 

LAWSON TAIT, F. R. C. S., BIRMINGHAM 

This writer (Diseases of Women, 1879), divides inflammatory 
affections of the ovaries into (1) ovarian hyperemia, (2) acute 
ovaritis, (3) chronic ovaritis. 

Ovarian Hyperemia. — This is frequently met with in young 
girls and in young married women with vigorous husbands, and 
in prostitutes of tender age. The patient should rest in a prone 
position for a few days before, during, and after the menstrual 
period ; a counter-irritant should be placed over the ovarian 
region just before the flow is expected ; and she should take ergot 
before and during the period, and the salts of potassium contin- 
uously during the intermenstrual time. His favorite formula is : 

9, I£. Ergotinae (Bonjean), gr. ss. 

Lupulinse, q. s. M. 

For one pill. 

In addition to this, between the epochs, 

10. I£. Potassii bromidi, gr. v-x. 
For one dose, night and morning, after meals. 

All cases of ovarian hyperemia which Mr. Tait has met with 
at puberty have yielded to this treatment, and most of those of a 
later age. 

Acute and Chronic Ovaritis. — No time can be laid down where 
ovarian hyperemia passes into ovaritis, nor between the acute and 
chronic forms of the latter. The treatment should consist of 
local and systemic rest, and the administration of ergot. Locally, 
counter-irritation in the inguinal region, with linimentum iodi 
every morning until the spot is sore, and this repeated frequently, 
will nearly always do good. Bromide of potassium may be com- 
bined with the ergot. Arsenic and cod liver oil are also useful, 
and some cases will yield to large doses of quinine, when every- 
thing else has failed. 



$0 DISEASES OF THE OVARIES. 

RESUME OF REMEDIES. 

Ammonia Murias is often efficient in ovarian neuralgia. (F. 6). 

Antimonii et Potassii Tartras. Counter-irritation by means of tartar 
emetic ointment is of service in subacute ovaritis. 

Atropia, hypodermically, xt^'A g ram m ovarian neuralgia. Bella- 
donna in plaster is often of service. 

Bro7niniitm. Barnes says that this agent seems to possess a specific 
power in diminishing ovarian irritation. 

Camphor a is very serviceable in ovarian pain. (F. i). 

Hydrargyri Unguentum. Dr. E. J. Tilt, of London, recommends in 
.subacute ovaritis — 

II. fy.. Unguenti hydrargyri, 3ij 

Extracti belladonnas, 5j 

Cera?, 3ij 

Adipis, |j. M. 

Warm water enemata, and gentle aperients (castor oil), should 
accompany the treatment. 

Iodinium. Painting the sensitive regions with tincture of iodine is a 

useful means of counter-irritation. 
Opium. Vaginal suppositories of opium gr. ij, made up with paraffin, 

frequently give great relief. Aran was accustomed to pour 

two drachms of laudanum daily or every other day, through a 

speculum, on and into the cervix. 
* Potassii Bromidum. This agent is asserted to possess almost specific 

powers in reducing ovarian irritation, and pain, nymphomania, 

etc. (F. 8, 10). 
Potassa cum Cake. In chronic ovaritis, Barnes recommends as a 

means of derivation, setting up a small issue or eschar on the 

vaginal portion of the uterus with this agent. 
Terebinthince Oleum, used in the form of hot epithems, is frequently 

available. 

general methods. 

Blisters over the ovarian region are frequently of service in the sub-acute 
forms. 

Enemata. Warm water enemata, retained as long as possible, are often 
of great benefit. 

Ice applied in a bag to the painful spot, is said by Dr. Tilt to relieve the 
pain of acute ovaritis. 

Leeches are a very valuable means of relief. (See page 26.) 

Pessaries. A light pessary, to support the womb and keep the ovaries 
in their normal position, will often prove of decided advantage. 

Ovariotomy. As a last resource in severe ovaritis, the organs may be re- 
moved by Battey's operation. 



OVARIAN TUMORS. 

The medical treatment of tumors of the ovaries embraces: 
Internal medication. 
Injections into the sac. 
Electrolysis. 
Internal medication. It has been believed by some practitioners 
that a prolonged use of muriate of ammonia has led to atrophy, 
absorption and disappearance of certain benign ovarian tumors. 
Two such cases are recorded at length by Dr. E. H. W. Hunter, 
in the Trans., of the Georgia State Med. Soc, 1877. He gave 
gr. xx of the muriate, four times daily. In ovarian dropsy, the 
free use of chlorate of potassa is said to have resulted in marked 
diminution of the contents. 

PROF. E. R. PEASLEE, M. D., NEW YORK 

Believed that, in several instances, tlje growth of ovarian cysts had 
been checked by the application into the vagina, of iodide of lead. 
The ointment may be smeared on a cotton tampon, and intro- 
duced from time to time. Care must be exercised that too great 
irritation is not excited. 

Injections into the sac. The substance usually employed for this 
purpose is iodine. Some surgeons use the pure tincture. Dr. 
Boinet, of Paris, employs — 

12. ty. Tinct. iodinii, f.^iij 

Potassii iodidi, 3j 

Acidi tannici, 5ss 

Aquae destillatae, f.giij. M. 

He injects the whole of this amount, brings it in contact with 
the entire surface of the* sac by gentle agitation, and then with- 
draws it. 

Prof. T. Gaillard Thomas recommends as the best procedure 
to empty the sac by the aspirator, and without withdrawing the 
needle, fill it with tincture of iodine, and in ten minutes draw it off. 
He would confine this plan of treatment only to a late period, in 
cysts of moderate size, with few compartments, and containing a 
fluid which is not very viscous. 

(31) 



32 DISEASES OF THE OVARIES. 

Electrolysis. Within the last few years, great attention has been 
given, especially in Germany, to the dispersion of ovarian tumors 
by electrolysis, and it was at one time confidently announced that 
this plan would supersede ovariatomy. 

Further observations show that while in many instances elec- 
tricity, properly applied, will reduce the tumors very materially, 
the effect of the agent is temporary, and it is very doubtful whether 
any permanent and real benefit accrues from the procedure. In 
Vienna, the electrolytic treatment has been carefully and repeat- 
edly tested, and it is now wholly neglected as of no avail. (See 
Am. Jour, of Obstetrics, Oct., 1878. 

EPHRAIM CUTTER, M. D., BOSTON, 

In a report to the Amer. Med. Assn., in 1879, says it is dangerous 
to operate on a person suffering with albuminuria. He regards it 
as proved, that the results obtained are due to the passage of a 
current, and not to solely to puncture. With Dr. Kimball, he has 
operated on 61 cases. In one case, the fibroid was extracted from 
the vagina fifty-three days after the application. In a similar case, 
there was a small, nodulated, mobile fibro-myoid attached at and in- 
corporated with the fundus. The os was ulcerated, and the operation 
was advised to arrest the hemorrhage. A current was applied for 
seven minutes. Two months after, no tumor could be felt, and the 
os was healed. In one case, an electrode was applied per vaginam, 
and the circuit was completed by a sponge electrode over the 
pubis, but with such alarming results that the procedure was shown 
not to be safe. It is best to confine the action of the current to 
the tumor, as it alone is in fault, and needs the whole force. This 
is effected by complete insulation of the needle in the healthy tis- 
sues. 



AMENORRHEA. 

JOHN WILLIAMS, M. D., LONDON. 

Referring to the classification of the forms of amenorrhea al- 
ready given (see page 21), this writer suggests the general line of 
treatment as follows {Lancet, May 26, 1877): 

Menstruation is and always has been absent. The great majority 
of cases of this class which will come under observation will be 
young girls between sixteen and twenty years of age. Many of 
them will suffer from anemia and disorders of the digestive organs. 
Such cases are instances oY late or tardy evolution of the genera- 
tive organs. The form and figure may be well developed, but the 
uterus grows slowly, and the treatment consists in waiting and 
adopting all means that favor its growth. There will, after all, re- 
main a few in which the discharge will not make its appearance. 
In these it will be found that the uterus is small, and the best 
treatment is non-interference. 

Menstruation is scanty or irregular. If it be due to an undevel- 
oped condition of the uterus, and if it be accompanied by no pain, 
the general health being good, it requires no special treatment. 
General means which favor physical development, as exercise of 
all kinds, may be recommended. If the uterus have obtained its 
full size, there will, in almost all cases, be found a disordered state 
of the general health. The most common condition is anemia. 
In such cases the physician should regulate the bowels, for there 
is generally constipation, and give iron, iodine, salines ; good diet, 
fresh air, and exercise in the open air, are essential. Exercises of 
all kinds are good — riding, walking, swimming, dancing. If the 
monthly molimen be present, emmenagogues may be prescribed, 
but they should never be administered when indications of ovarian 
and uterine action are present. The medicines supposed to have 
a direct action in bringing on the menses are numerous, but few of 
them are of much or even of any value. The best are electricity, 
aloes, and the stimulating diuretics — nitrous ether, spirits of juni- 
per, and oil of turpentine. Hot hip-baths for five or six nights in 
succession before the expected return of the molimen are useful. 
Guaiacum, ergot of rye, oil of savin, cantharides, have proved suc- 
cessful in the hands of some. Dr. Atthill recommends the warm. 
3 (33) 



34 DISEASES OF THE OVARIES. 

hip-bath for eight or ten evenings in succession before the ex- 
pected time. 

Suppression of the menses. When the suppression has taken 
place suddenly during a menstrual flow, the patient should have a 
hot bath, go into a warm bed, and take a dose of Dover's powder. 
A stimulating diuretic or a diaphoretic should be at the same time 
prescribed. Should fever, heat in the skin, vomiting, pain in the 
abdomen, and symptoms of local inflammation or of general peri- 
tonitis set in, they should be treated irrespective of the suppres- 
sion. If the flow is not re-established, the case becomes one of 
chronic suppression. 

Chronic suppression. The general health should be attended to, 
and if menstrual molimina be present they should be encouraged, 
and efforts made to establish the flow by the means already enum- 
erated. If molimen be absent, we must limit our aid to the treat- 
ment of the general health. 

PROF. R. J. GRAVES, M. D., DUBLIN. 

This author observes, in his Clinical Lectures, that the periodicity 
of the function of menstruation can still be traced, even in cases 
where suppression has continued for a great length of time, by 
means of the menstrual molimina (pains in the loins, thighs, and 
hypogastric region, flushing, colicky pains of the abdomen, general 
feeling of malaise), which occur at stated intervals ; in endeavoring 
to bring on the discharge, therefore, we must be guided as to the 
time the attempt should be made, by an observance of the period 
at which these molimina occur. For a few days before that time, 
our efforts to produce a determination of blood to the uterus may 
be judiciously employed; and if they fail, the attempt should be 
abandoned until a few days before the next menstrual period. Of 
course, however, the general constitutional treatment must be con- 
stantly persevered in; one of the chief means of bringing back 
this evacuation being the restoration of health to the natural stand- 
ard. But all such remedies as pediluvia, stuping of the genitals, 
leeches to the inside of the thighs, near the labia, aloes and other 
stimulative purgatives, etc., should be only used at the times 
spoken of. To use them at any other period, either after the 
molimina have disappeared, or during the intervals between them, 
tends, in most cases, still further to derange nature, by determining 
to the uterus at an unseasonable time, when there is no natural 



AMENORRHEA. 35 

tendency to that organ. Under such circumstances, the very same 
means fail and prove injurious, which, applied so as to coincide 
with the time of the natural effort, would have been successful. 

To illustrate these principles by an example. We are consulted 
in the case of a young woman affected with various hysterical 
symptoms for several months, and during that period more than 
usually subject to headache, languor, loss of spirits, diminution of 
appetite, and irregularity, and usually constipation of bowels; she 
is pale, and complains of various pains and uneasy sensations, and 
has not menstruated since the appearance of these symptoms. 
Here it is evident that the constitutional treatment must be 
strengthening and tonic. The practitioner will, therefore, recom- 
mend regular hours, much exercise in the open air, a nutritive diet, 
and afterward cold shower-baths ; he will regulate the bowels, and 
afterward prescribe a course of tonic medicines, chalybeates, pre- 
parations of bark, strychnia, etc. ; he will likewise inquire carefully 
when the last period happened, and where, and how often since that 
occurrence menstrual molimina were observed. He thus ascer- 
tains when they should again recur, and contents himself with en- 
forcing the constitutional treatment until about six days before the 
calculated time. Then he lays aside the other medicines, and has 
recourse to those means which determine to the uterus. Two 
leeches are applied to the inside of the thigh, near the labium, 
every second night, until they have been three times applied. The 
bleeding is encouraged by stuping. On the intermediate days the 
bowels must be actively moved by aloetic pills; and for three 
nights before and after the molimina, hot pediluvia, rendered stimu- 
lating by mustard seed, may be used. During the same time, also, 
frictions, with stimulating liniments, should be applied to the feet 
and legs every morning, and oil of turpentine or tincture of can- 
tharides may be exhibited internally, while the necessity of more 
active exercise is inculcated. If these means fail, they must for 
the moment be laid aside, and the constitutional treatment must 
be again resumed, until the same number of days before the next 
period, when the list of remedies above spoken' of must be again 
tried, and in few cases indeed shall we find them to fail. 

PROF. T. GAILLARD THOMAS, M. D., OF NEW YORK, 

In cases of rudimentary or atrophied uterus suggests local stimu- 
lation and distention. Every week or two it should be distended 



36 DISEASES OF THE OVARIES. 

by a tent. In the intervals, an intra-uterine galvanic pessary 
should be worn. This however, requires time. After general 
treatment, in cases of anemia, etc., he uses other local stimulation 
by dry-cupping the cervix uteri. Electricity is of value. One 
pole of the battery may be placed over the lower part of the spine, 
and the other either passed over the hypogastrium, or brought in 
contact with the neck of the womb; or it may be carried within 
that organ by means of a wire covered with a gum catheter. 

E. J. TILT, M. D., OF LONDON, 

Advises a couple of aloes and myrrh pills each night, to produce 
moderate alvine action ; the legs placed in a pail of hot water on 
rising, and a warm hip-bath at night ; mustard to the inner parts 
of the thighs and breasts on alternate nights ; the breasts dry- 
cupped, or rubbed with a stimulating liniment. On retiring, a 
linseed meal poultice as hot as can be borne to the lower part of 
the abdomen. These measures are to be tried for three days, and 
again after an interval of twenty-one days, and in the interval, a 
chalybeate is to be taken, and a bit of piline sprinkled with alco- 
hol to be worn during the day over both ovarian regions. This 
he continues for three or four months. Occasionally, during the 
three day, he gives a mixture of acetate of ammonia, chloric ether, 
and fluid extract of ergot. When the head is much distressed, he 
applies six leeches to the labia, followed by a hot hip-bath, or a 
hot poultice to the labia. 
He offers the following: 

13. I£. Oil of savin, f.5j 

Spirits of nitrous ether, f-5iij 

Mucilage, f.§j 

Water, to fjvj. 

Shake well. Dose. — A teaspoonful every two hours, when the patient 
is half comatose from suppressed menstruation. 

Or, 

14. I£. Tincture of ergot, f.5ij 

Syrup of saffron, f.§ss 

Comp. decoction of aloes, f.§iss. 

Dose. — A teaspoonful three times a day. 

He recommends the association of podophyllin and aloes, in 
pills, for the same purpose. 



AMENORRHEA. 37 

PROF. ROBERT BARNES, OF LONDON, 

Thinks that the blood is in want of salines as well as of iron, and 
that this is the first want. He gives solution of acetate of 
ammonia, adding a little nitrate of potassa, and a light tonic as 
hop, cinchona or calumba. He employs iron in the form of the 
ammonia-citrate, the solution of the acetate, or the dialyzed iron. 
Between salines and iron, he would give iodide of potassium in 
doses of five grains three times a day. He believes that the res- 
torative power of iron is much increased by the addition of strych- 
nine or ergot. 

PROF. J. B. FONNSAGRIVES, OF PARIS. 

This learned author divides amenorrhea, for the treatment, 
into the following classes : 

1. Plethoric amenorrhea. Local and general bleeding, the re- 
sinous purgatives, and low diet, are here indicated. Siredey rec- 
ommends in addition bicarbonate sodium, gr. v. daily, two or three 
days before the period ; or solution of the acetate of ammonia. 

2. Nervous amenorrhea, characterized by a condition of general 
nervous erethism. Raciborski in such cases gives twenty to 
thirty drops of the solution of acetate of ammonia, in hot water, 
several times daily, for three or four days before the period, and 
also has recourse at times to ergot and vaginal fumigations with 
carbonic acid gas. 

3. Tuberculous and scrofidous amenorrhea require the general 
treatment of dyscrasise. 

4. Amenorrhea by cotmter-fluxion. This arises when some other 
organ, by reason of its congestion, checks or prevents the normal 
uterine molimen of the menses. In such cases the attention of 
the practitioner must be directed to removing the congested con- 
dition of the interfering organ. 

DR. EMIL DILLENBERGER, VIENNA. 

Treatment demands the removal of those errors and lesions 
which lie at the bottom of the malady, If the amenorrhea con- 
sists of some anomaly of the sexual organs, congenital or ac- 
quired, and such as cannot be remedied, or in some other irre- 
mediable malady, treatment is useless. If menstruation has been 
already established, the physician must convince himself, by a 
careful examination, whether or not pregnancy is the cause of the 



38 DISEASES OF THE OVARIES. 

cessation of the periods. Internally are used aloes and myrrh, as 
follows : 

15. fy. Pulveris aloes, gr.lxviij 

Pulveris myrrhae, gr.xxxiv 

Extract! glycyrrhizae, q. s. M. 

For sixty pills. Two to four pills two or three times a day. 

16. I£. Pulveris aloes socotrinae, 

Pulveris myrrhae, aa gr.xlviij 

Croci.sativi, gr.xxxiv 

Extracti glycyrrhizae, q. s. M. 

For ninety pills. From four to six twice a day. 

Or, savine, as follows : 

17. ^. Pulveris frondis sabinae, 

Sacchari albi, aa gr.xxxiv 

Olei menthae piperitae, gtt.iij M. 

Divide into six powders. One to be taken three times a day. 

18. fy. Olei sabinae, gtt.vj-xij 

Sacchari albi, gr.lx. M. 

Divide into six equal powders. Put in waxed paper. Take one pow- 
der three times daily. 

19. ^. Pulveris frondis sabinae, gr.lxviij 

Croci sativi, gr.xxij 

Olei sabinae, gtt.viij 

Extracti gentianae, q. s. M. 

For sixty pills. From three to five pills two or three times daily. 

Or, direct crocus and borax, as follows : 

20. ]£. Boracis venalis, gr.xxxiv 

Croci sativi, gr.xiij 

Sacchari albi. gr.xxij 

Olei menthae piperitae, gtt.j. M. 

Divide into six powders. One powder three times a day. 

Amenorrhea is often more certain to be cured by putting an 
end to serous or bloody discharges from various organs, by treat- 
ing for an improved condition of the blood, with good nourish- 
ment and a corresponding regimen, with iron, preparations of cin- 
chona, cold washing, etc., than by theemployment of emmena- 
gogues without any plan. 

For outward application, the following are useful : Warm uterine 
douche; brushing the mouth of the womb with tincture of iodine ; 
leeches to the portio vaginalis uteri, to the labia pudendi, to the 
inner side of the thighs, or to the perineum ; dry cuppings 



AMENORRHEA. 39 

and mustard poultices to the inner sides of the thighs ; warm 
stimulating foot-baths, with mustard, salt, potash, or aqua regia ; 
warm sitz-baths, or half-baths ; bath at Ems, etc. In many girls 
marriage is the first thing that regulates the menstruation. 

DR. FRITZ, OF PARIS. 

This writer gives the following directions in the Union Medicate, 
No. 151, 1878. If the flow has been suppressed by the patient's 
catching cold, warm hip-baths, vapor-baths, and stimulating foot- 
baths will be found useful. The patient must be well covered with 
warm clothing, and take sudorific drugs and stimulants, such as 
ether, acetate of ammonia, or infusion of lime blossoms. Hot fomen- 
tations must be applied to the lower part of the abdomen and the 
genital organs, arid mustard plasters to the inner surface of the 
thighs ; cupping might be advisable instead of mustard. Stimu- 
lating injections will also be found very useful. 

This treatment has to be continued for some days, and renewed 
when the next period is due. If the patient is plethoric, and con- 
gestions have been determined in the pelvic organs by the sup- 
pression of the period, leeches must be applied to the perineum, 
the labia, or the thighs cupped, and if the patient be constipated, a 
purgative must be given. If the suppression be caused by some 
moral cause, and the woman is excitable, the nervous system must 
be treated with antispasmodics and sedative drugs. 

HOSPITAL OF THE UNIVERSITY OF PENNA., PHILADELPHIA, 

In amenorrhea from anemia and chlorosis, the following pre- 
scription embodies the hospital practice : 

21. I£. Pulv. ferri sulphat, 

Potassii carb. purae, aa 5ij 

Mucil. trag acanthi, q. s. M. 

Div. in pil. No. 48. 

S. To be given daily in doses gradually increasing, until three pills 
are taken after each meal. 

This gives the large quantity of twenty-two and a half grains of 
the dried sulphate of iron per diem. 

To counteract the possible costive effect of the sulphate of iron, 
this aperient mixture is given : 



40 DISEASES OF THE OVARIES. 

22. I£. Pulv. glycyrrhizas rad., 

Pulv. sennas, aa ^ss 

Sulphuris sublim., 

Pulv. fceniculi, aa 3ij 
Sacchar. purif, §iss. 

S. One teaspoonful in half a cupful of water at bed-time. 

Where the disease is due to torpidity of the ovaries, this pre- 
scription is used : 

23. 3. Ex. aloes, 5j 

Ferri sulphat. exsic, 3ij 

Assafcetidas, 3iv. 

Signe. One pill after each meal. This number to be gradually in- 
creased to two and then to three pills after each meal. If the bow- 
els are at any time over-affected, return to the initial dose of one 
pill after each meal. 

DR. PINTSCHOVIUS, OF KETZIN. 

24. I£. Extracti pulsatillse, 

Foliorum Pulsatillas, aa q. s. 

Divide into pills of three grains each ; one three times a day. 

PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 

25. I£. Apiol, gr. iv. 

In the form of a granule, or " pearl," four times a day, as an 
emmenagogue. To be taken for three days before the expected 
period. Apiol is an excellent remedy for amenorrhea, when there 
is no uterine disease. 



PROF. COURTY, OF PARIS. 




26. 1$.. Pulv. rutas, 

Pulv. sabinas, 
Pulv. ergotae, 
Pulv. aloes, 

For one pill. 


aa gr.f, 
gr.i" 



Of these thirty are Ordered, and three are taken the first day, 
six the second day, and nine the third day, always in three doses. 
They are suited for cases of idiopathic amenorrhea, without great 
reaction on the economy, and when there is reason to suppose 
that the suppression of the menses is due either to an insufficient 
determination towards the genital organs, or to a difficulty of dis- 
charge due to inertia of the uterus. In order to encourage the 
fluxion towards the genital organs, Dr. Courty orders, before be- 
ginning the pills, foot-baths, sitz-baths, and fumigations. He also 






AMENORRHEA. 41 

applies leeches to the labia during the three days the pills are be- 
ing taken. The pills generally induce colicky pains, and often a 
little diarrhoea. 

RESUME OF REMEDIES. 

Achillea Millefolium ( Yarrow). Dr. Ronzier-Joly reports very success- 
ful use of this plant in amenorrhea in tuberculous girls. He 
uses an infusion of the flowering tops, 5iij to aquae Oj. Stille 
believes that this plant possesses peculiar relations to the pelvic 
organs. It is especially called for where imperfect or absent 
menstruation depends upon a condition of atony in the repro- 
ductive organs. 

Aconitum may be employed, in the form of the extract, with advantage in 
amenorrhea. Dr. "Ringer, of London, recommends it in the 
sudden suspension of the menses, as from cold. 

Aloes, in a small enema, containing gr. x, employed at the proper men- 
strual period, is said to be a very certain emmenagogue. Dr. 
E. J. Tilt, of London, recommends its internal administration 
combined with podophyllin. It is frequently combined with 
myrrh. 

Aloin. Dr. Tilt gives : 

27. ^. Aloin, gr. ij 

Cocoa butter, gr. x. 

Make a suppository. 

Ammonii Murias, in the hands of Dr. Anstie, in gr. x doses, three times 
a day, in cases of amenorrhea marked rather by general feeble- 
ness than by anemia, has occasionally seemed to conduce di- 
rectly and considerably toward the cure. But of this, as of all 
other emmenagogues, it is pre-eminently true that it is worth 
absolutely nothing if not exhibited precisely on the fit occasion. 

Ammonia Aqua has been successfully employed in the form of injection 
into the vagina : 

28. ty. Aquae ammoniae, f.3j 

Lactis, Oj— ij. M. 

To be injected into the vagina daily. 

Apiol is highly recommended by Dr. Jaret (Bull. Gen. de Therap., 
August 15, t86o), and others since, as one of the safest and 
best of emmenagogues, not being even contra-indicated in inci- 
pient pregnancy. It is said to be especially adapted for cases 
attended with local or general nervous symptoms. (F. 24.) 

Argenti Nitras, applied in substance lightly to the os uteri at the time of 
the expected appearance of the menses, has proved successful in 
obstinate cases. 

Artemisia Vulgaris. The mugwort once enjoyed considerable reputation 
as an emmenagogue. 



42 DISEASES OF THE OVARIES. 

Belladonna. In plethoric amenorrhea, belladonna is an efficacious 
remedy. It is quite popular on the continent and recently Dr. 
F. T. Porter, of Dublin, has reported marked success with it. 

Cantharides . Dr. W. P. Dewees placed much confidence in the internal 
use of tincture of cantharides, in doses of gtt. xx., gradually 
increased to gtt. xxxv. or xl. Dr. T. H. Tanner, of London, 
combined it with bromide of potassium. 

Ciniicifuga has been found an effectual remedy in some cases. 

Crocus Sativus. The saffron as a stimulant aromatic has efficacy in func- 
tional amenorrhea. The celebrated " Pills of Rufus " are com- 
posed as follows : 



29. fy. Aloes, 

Myrrhae, 

Croci, 

Syrupi absinthii, 


gr. iss 
gr-i 

g r - -h 

q. s. 


For one pill ; 5 to 10 pills daily. 





* Ergot is recommended by Dr. Tilt, of London (in doses of gr. v-x, in 
powder, two or three times a day). He usually gives it in con- 
junction with other remedies : 



Or, 



30. fy. Tincturae ergotas, 
Syrupi croci, 
Decocti aloes compositi, 


nixxx 

f.?ss 
f.3iss. 


A teaspoonful three times a day. 




31. I£. Liq. ext. ergot., 
Prepared lard, 
Cocoa butter, 


f.5j 

gr.iv 

up to gr. xv 


Make a suppository. 





M. 



*Ierrum Redactum, and the other ferruginous preparations, are indis- 
pensable in the anemia which constantly accompanies stoppage 
of the function. 

Galbanum may frequently be combined, with benefit, with the salts of 
iron. 

Hydrargyri Chloridum Mite is contra-indicated, if the patient be feeble, 
and is capable of doing much mischief in unsuitable cases. 
But Drs. Graily Hewitt, Ashwell, and others, have found it 
a decided emmenagogue. Dr. Hewitt directs that on two 
successive nights, at the time of the expected period, a dose be 
given of five grains of calomel and six grains of aloes, followed 
by a Seidlitz powder in the morning. 

Iodine frictions over the abdomen have been found to give good results. 

Iodoform, internally, has been recommended. 

32. I£. Iodoformi, 

Extr. gentianae, aa 5j 

Pulv. gentianae, q. s. 

Make 100 pills. Three to six daily. 



i 



AMENORRHEA. 43 

Mentha Pulegium. Pennyroyal has a popular reputation as an emmena- 
gogue. 

Mywh, in combination with iron and aloes, is a standard remedy in amen- 
orrhea. Dr. Tilt, of London, recommends the following so- 
called " Elixir of Paracelsus :" 

33. I£. Tincturae myrrhae, f.^iv 

Tincturae croci, 

Tincturae aloes, aa f.^iij. M. 

F.5ij-iij, twice daily, in a little water. 

Potassii Bromidum. The value of bromide of potash in amenorrhea, 
especially that connected with nervous and hysterical phenom- 
ena, neuralgia, ovarian irritation, scanty and painful menses, 
has lately been strongly urged by Dr. M. Rosenthal, of 
Vienna ( Wiener Med. Presse, No. 46, 1878). He repeats it in 
full doses for some days before the menses begin. 

Pulsatilla is said by Phillips to be of the greatest value in functional 
amenorrhea, and that following fright or chill ; gtt.j-v of the 
tincture three or four times a day. 

Ruta Graveolens. The rue has been recognized as a direct emmena- 
gogue since the time of Hippocrates. As it is a decided irri- 
tant of the intestinal canal, it must be given with caution. 
According to E. Hamelin {Diet, des Sciences Medicates, 1877), 
it is especially indicated where suppression is due to atony or 
inertia of the uterus. The powder is used by Dr. Courty 
(F. 26). A better preparation is the essential oil. The follow- 
ing is from Dr. Dubois : 

34. fy. Oleirutae, 

Olei sabinae, aa gtt.vj 

Sacchari, 3vij 

Rub together and add 

Aquae aurant. flor., f.^iiss. M. 

A dessertspoonful every hour. 

A rectal injection of an infusion of rue, 5j to Oj, is occasion- 
ally serviceable. 
Sabina is considered by Dr. Tilt, of London, as the most reliable of a 
■ very uncertain set of remedies. He has never seen any ill effects 
from its use, though he has given gtt.xx. of the oil, twice a day. 
He orders : 

35. fy, Olei sabinae, f.5j 

Spiritfts setheris nitrosi, f.5nj 

Mucilaginis, f.^j 

Aquae, f.fvj. M. 

A teaspoonful every two hours, the bottle being previously 

shaken. A plaster containing the oil may also be worn over 

the ovarian region. 

Pereira, Home, Phillips, Locock, and Sir Charles Clarke, 
all testify to its efficatcy. 



44 DISEASES OF THE OVARIES. 

Senega was first recommended as an emmenagogue by Dr. Hartshorne, 
of Philadelphia. He gave a pint of a saturated decoction daily 
during a fortnight before the expected appearance of the dis- 
charge. 

Sinapis. A hot mustard hip-bath is often useful, the patient remaining in 

it for an hour each time. 
Sodii Biboras. Dr. Copland recommends the following : 

36. R. Sodii biboratis, 5ss 

Aloes socotrinae, 

Pulveris capsici, aa gr.xx 

Olei lavandulae, q. s. 

Make eighteen pills. Take two thrice daily. 

Strychnia. Small doses of the extract or alkaloid of nux vomica, com- 
bined with aloes and myrrh, are sometimes of service. 
Tanacetum has a popular reputation. 
Terebinthince Oleum. Turpentine enemata have been given with success: 

37. R Oil of turpentine f.^ss 

Barley water. Oj. 

For one enema, to be given once or twice a day. 

Zingiber. Hot ginger tea is a popular remedy for suppression from cold. 

GENERAL MEASURES. 

Electricity. This agent has been found useful in various instances. In 
chronic suppression, Dr. P. S. Hayes, of Chicago, places one 
of the electrodes alternately over each ovary and the uterus, 
the other electrode over either sacro-iliac synchondrosis, the 
current being frequently reversed {Chicago Medical Examiner, 
Jan. 1875). Dr. Julius Althaus considers the most effective 
form of applying electricity in amenorrhea to be the induction 
of catelectrotonus of the ovaries {Medical Times and Gazette, 
March 14, 1874). He places the negative electrode of the con- 
stant battery, alternately to the right and left ovarian region, 
putting the anode alternately to the lumbar spine and to the os 
uteri, by means of an insulated sound. The action should be 
kept up for fifteen minutes at a time, and repeated daily about 
the period the molimen should recur. The late Sir James 
Simpson was accustomed to use, with advantage, an intra- 
uterine galvanic or zinc and copper pessary, in the treatment of 
amenorrhea, the result of imperfect development of the 
uterus. 

Leeches. Trousseau strongly recommends leeches. His method of 
using them was peculiar. He placed a single one, or at most 
two, on the thigh or knee at the time the menses were due. As 
soon as the leech fell, he arrested the bleeding, so as to promote 
congestion of the surrounding tissue. Sometimes, he asserts, 
the menstrual pains begin almost as soon as the bleeding is 
thus checked. 



AMENORRHEA. 45 

Massage. This is appropriate in cases of suspended menstruation. Dr. 
Douglas Graham of Boston, has given some illustrations of 
its successful employment {Boston Medical and Surgical Jour- 
nal, Feb., 1876). The mode of procedure is manipulation of 
the whole body, with percussion of the back, resisting move- 
ments of the feet, legs, and thighs, in all their natural direc- 
tions ; this being repeated daily. 

Milk Diet. A strict skim-milk diet has been found successful by Prof. 
Tarnier of Paris, in several cases of amenorrhea in obese 
young women. With the disappearance of the extra fat, the 
menses returned. 

Baths. Sitz-baths or footbaths, using salt water or mustard water, are 
often sufficient where there is suppression following exposure. 
The mustard should be placed in a linen bag and soaked with 
occasional pressure in the water, until the latter receives a 
greenish color. I'he time of the bath should be fifteen to 
twenty minutes. Atthill especially commends the cold hip- 
bath. He directs the patient to sit in a bath containing cold 
water, so as to cover the pelvis, the legs and feet not being 
immersed, but kept warm by coverings of flannel, or by a pan 
of hot water. The temperature of the bath should be about 
6o° ; taken at bedtime, and for a period of from five to fifteen 
minutes ; after which the patient should be well rubbed with a 
coarse towel, and put to bed. Chilliness must be obviated by 
a hot jar to the feet, and if there is discomfort after the bath, 
it should not be repeated, or used for a shorter period. This is 
not applicable where there is anemia, or constitutional disease. 



DYSMENORRHEA. 

PROF. T. GAILLARD THOMAS, M. D., OF NEW YORK. 

Pursuing the classification of the forms of dysmenorrhea, given 
by this authority (See page 22), he recommends the following 
plans of treatment : 

Neuralgic Dysmenorrhea. The skin should be kept warm and 
active by wearing flannel, and bathing. If the rheumatic or gouty 
diathesis is present, colchicum, guaiac or vapor baths are called 
for. Chlorosis, plethora, or malaria, if present, should receive 
attention. A sound should be occasionally introduced into the 
uterus. Parturition often cures it entirely. Of specific drugs, 
apiol is the most reliable (one capsule night and morning). 
Tincture of cannabis indica, gtt. xxv. every fourth hour, will relieve 
the pain. Where a spasmodic element exists, the following is 
effectual : 

38. fy. Extracti belladonna?, g r -X 

Butyri cocose, . q.s. 

For one vaginal suppository. Repeat every eighth hour. 

Enemata of tincture of assafcetida, f.5ij in a gill of warm water, 
oiten produce great relief in this condition. 

Congestive Dysmenorrhea. If from chill and exposure, opiates, 
diaphoretics and sedatives will give speedy relief; if from plethora, 
bleeding, cathartics and low diet are required ; if from a displaced 
uterus, as is often the case, this must be corrected. Local inflam- 
mations must receive attention before a cure can be expected. 

Obstructive Dysmenorrhea. Constrictions of the cervix require 
enlargement, either by dilatation or incision. Sounds, tents, and 
dilators, are used for the first mentioned methods. Sea-tangle, 
sponge, etc., are materials of which tents may be composed. 
Obstruction from flexion or version of the uterus requires a proper 
pessary or operation. 

Membranous Dysmenorrhea. This is relieved with difficulty. As 
soon as the menses begin, the patient should go to bed and apply 
hot water bottles to the feet, abdomen and sacrum alternately. 
She should then take an enema : 

(46) 



DYSMENORRHEA. 47 

39. I£. Tinct. assafetidae, f.3iij 

Tinct. belladonnae, gtt.xx 

Tinct. opii, gtt.x 

Aquae tepidae, f.^iijss 

Throw the whole into the rectum and retain. Instead of this, 
the following may be given by the mouth : 

40. JE£. Chloral hydratis, 

Potassii bromidi, aa 5ij 

Morphiae sulphatis, g r \\ ss 

Syrupi aurantii corticis, f.^iij. 

A dessertspoonful in a wineglass full of water every four hours while 
in pain. 

Ovarian Dysmenorrhea. The most efficacious remedies are the 
bromides of potassium arid ammonium, in full doses, commenced 
a week before the menstrual act, and continued until its close. A 
rectal suppository of gr. v. iodoform, gives great relief. Change of 
air and scene, warm sitz-baths, or warm vaginal injections, and 
general hygienic measures, are essential. 

LAWSON TAIT, F. R. C. S., BIRMINGHAM. 

Ovarian Dysmenorrhea. In milder cases, treatment is generally 
successful. First of all therapeutic remedies is iron, whether 
there are general indications for its employment or not. There 
can be no doubt but that many forms of this remedy exert a spe- 
cific power over the sexual organs. It is best given during the 
intermenstrual period in small doses, liquor ferri perchloridi, gtt.j- 
v, well diluted, and increased suddenly to gtt. xv-xx, for a day or 
two previous to and during the menstrual flow ; or an iron and 
aloes pill may be substituted for this large dose. Hot hip-baths 
and leeches to the perineum at the period are useful additions, 
with an occasional blister on the sacrun. Marriage is, perhaps, 
the most efficient remedy, and one we ought seldom to hesitate to 
recommend. 

The last and most powerful aid is mechanical irritation of the 
uterus. The most convenient and least troublesome is the inser- 
tion of Simpson's galvanic pessary. In a large number of cases 
this is beneficial ; but its use should be confined to those which 
resist simpler measures. Its introduction may give rise during 
the first week to considerable discomfort, but this passes off if the 
patient keeps her bed for a few days. It should be retained for 
several months. The uterus rapidly enlarges under its action, and 



48 DYSMENORRHEA. 

the ovaries take part in this increased activity. Mr. Tait does not 
share the prejudice against this instrument which some writers 
have manifested. 

CHARLES R. DRYSDALE, M. D., OF LONDON. 

This author maintains {Obstetrical Journal of Great Britain, Oct., 
1875,) that there is too great a tendency to expect to find an evi- 
dent physical cause for all painful menstruation. Spasm and neu- 
ralgia are quite sufficient to account for the vast majority of cases. 
Membranous shreds, also, are frequent causes of obstruction to the 
monthly flow. The rational treatment of dysmenorrhea commen- 
cing at an early period, consists not in the use of pessaries, or of 
incision of the uterus; but in the use of cold baths in the morning, 
with short walks in the open air afterwards; in hot baths, a few 
days previously to the menstrual periods ; and in palliative treat- 
ment of the paroxysms by means of antispasmodics at the epoch 
of pain. Marriage sometimes cures such cases at once; at other 
times, it is of no use. 

PROF. J. MATTHEWS DUNCAN, M. D., OF EDINBURGH. 

This teacher strongly advocates the treatment of dysmenorrhea 
by mechanical means. He would not hesitate to employ it in vir- 
gins when the severity of the case was urgent. The treatment he 
refers to is that by bougies introduced into the cavity of the 
womb through the cervix. He states that it is unaccompanied by 
danger. The only evil result he has ever seen from it is a tem- 
porary perimetritis. It is a treatment the innocence of which 
arises from the fact that there is no cutting, and that the instru- 
ment is not left in the womb above a few minutes at a time. It is 
allowed to remain till the pangs of pain which it brings on have 
passed. In order to effect a cure you must go up considerably 
above a No. 9. You must go up so as to stretch and distend the 
internal os uteri ; and this stretching or distention of the internal 
os may require you, in different cases, to reach different sizes. A 
No. 1 1 is quite sufficient in many cases ; in others you will go up 
to a 12 or 13, rarely above that. These various numbers are not 
all used in one day, but in successive days, or every second or 
third day, and generally the whole is effected in a few sittings — 
say from four to eight. You are not to expect that this treatment 
will cure every case. By this treatment he says that most of the 



DYSMENORRHEA. 49 

characteristic cases are, if not cured, at least greatly amelio- 
rated. 

PROF. F. A. ARAN, OF PARIS. 

This well-known gynecologist has highly praised the local ap- 
plication of opium in neuralgias of the uterine neck, which some- 
times accompany dysmenorrhea {Bull, de Thcrapcutique,vo\. lxvii). 
His method is as follows: Having introduced a speculum, thirty 
to fifty drops of Sydenham's laudanum are allowed to flow to the 
bottom of the vagina ; sufficient powdered starch is then thrown 
in to form a magma with the laudanum; upon this is placed a 
moderately large pledget of cotton, and the whole is left in the 
vagina, to be renewed daily or every other day as occasion re- 
quires. He reports very great relief by this simple means. 

PROF. J. B. FONNSAGRIVES, OF PARIS. 

For therapeutical purposes this writer (Traite de Therapeutique 
Appliquce, 1878), divides dysmenorrhea as follows : 

1. Spasmodic Dysmenorrhea. The flow is normal in quantity 
and regular, but accompanied by sharp pains, and easily inter- 
rupted. The indications are, baths and anti-spasmodics, as an 
enema : 

41. I£. Powdered valerian, 5iii 

Laudanum 10 drops 

Warm water, 8 oz. M. 

For a rectal enema. 

Or the valerianate of ammonia maybe used in a similar manner. 
Hot poultices to the lower abdomen and sedative lotions to the hy- 
pogastric regions are also useful. Of internal remedies, two espe- 
cially deserve mention, the acetate of ammonia and castoreum. The 
former should be given in doses of a fluidrachm well diluted, 
several times daily for several days before the period. Castoreum 
is especially indicated where the pains are associated with disten- 
tion of the bowels and tympanites, or when the discharge is 
scanty and tenesmus uteri present. Its power is then real and pos- 
itive. It may be given in pill, powder, or ethereal tincture, in doses 
of gr. v-xxx. Its failure is often owing to the impurity of the 
drug. 

2. Dysmenorrhea from general causes, as anemia, plethora, ner- 
vous excitement, etc. As here the disturbance of the function is 
merely symptomatic, it should be so treated. 

4 



50 DISEASES OF THE OVARIES. 

3. Dysmenorrhea through insufficiency. When the proper amount 
of blood has not been lost, the woman experiences general dis- 
comfort, sense of weight at the hypogastrium, hysterical symp- 
toms, obstinate headache, and local congestions. The indication 
here is to supplement the menses by a moderate bleeding from 
the arm (f-Siij-vj), or by leeches. 

4. Menorrhagic Dysmenorrhea is nearly always associated with 
the change of life, and will be considered under that section. 

5. Irregular Dysmenorrhea. The quantity is normal, but the 
periods of return are irregular and the function painful. This is 
generally found either at the beginning or the close of menstrual 
life, or at the outset of diathetic disease. In other cases, it is 
proper to solicit the molimen at regular times by emmenagogues. 

DR. EMIL DILLENBERGER, VIENNA. 

When there is evident hyperemia of the womb, several leeches 
to the portio vaginalis uteri, or to the insides of the thighs, warm 
soft poultices, or injections of lukewarm water, are very beneficial. 
When the dysmenorrhea is of nervous origin, some advantage is 
derived from the application of warmth, warm baths, mustard 
poultices, or dry cuppings applied to the loins and thighs, and 
internally from narcotics, especially opium. 



42. I£. Pulveris opii, gr.j 

Sacchari albi, 3j 

Olei menthse piperitae, gtt.ij. M. 

Divide into six powders. Take one every two to four hours. 



Or 



43. I£. Tincturas opii, "nixxx 

Infusi anthemidis, f.^iv 

Aquae menthae piperitae, 
Syrupi simplicis, aa f.fss. M. 

One to two tablespoonfuls every one or two hours. 



PROF. THEODORE JEWETT, M. D., BOWDOIN MEDICAL COLLEGE. 

44. fy. Camphorae, 3ijss 

Extracti belladonnas, 

Ouiniae sulphatis, aa 3ss 

Pulveris acaciae, q. s. M. 

For eighty pills. One to be taken every four hours until relieved. 



DYSMENORRHEA. 5 1 

45. I£. Extracti Scutellariae fluidi, 

Decocti aloes compositi, aa f.^ss. M. 

A dessertspoonful every two or three hours until relieved. 

Dr. C. W. Frisbie, of East Springfield, N. Y., writes that he 
used the above formula in his practice many times, and, when the 
cases had been properly selected, with the most happy results. 

DR. A. DESPREZ, SURGEON TO THE LOURCINE HOSPITAL, PARIS. 

In dysmenorrhea, warm water occasions congestion of the 
uterus, and the congestion is followed by a return of the menses, 
and consequently by a marked alleviation. 

Injections of warm water act like the cataplasms and warm 
lotions, which are so usefully employed in inflammation of the 
integument. 

The injections of warm water are practiced at the hospital with 
irrigators, of which the jet is not very strong. The water used 
should be of 95 ° to 104 Fah., and it is renewed two, four, or six 
times in a day. This therapeutic means is convenient, and not 
repugnant to the patient. 



DR. LISFRANC, PARIS. 

46. $. Vini opii, gtt.x-xx 

Camphorse, gr.ij-ivss 

Decocti althaeas, f.gijss 

Vitel. ovi, 3ijss. M. 
For an enema, to be given nearly cold, at bed-time, to relieve the pain 
of menstruation. Hot fomentations on the abdomen. 

47. $. Assafetidae, 3j 

Vini opii, 1 v\xv 

Extracti Valerianae, 3ss 

Decocti althaeae, f.giijss 

Vitel. ovi, 3v. M. 
An enema, in hysterical dysmenorrhea. 



HENRY HARTSHORNE, M. D., OF PHILADELPHIA. 

Whatever be the cause of dysmenorrhea in any case, the sub- 
ject of it should always avoid being much on her feet for a day or 
two before her monthly time ; and should go to bed when the pain 
begins. Cloths wrung out of hot water, or whisky and water, 
may be placed on the abdomen and renewed as they cool. Inter- 
nally the following may be given : 



52 DISEASES OF THE OVARIES. 

48. fy. Spiritus camphorse, f.5j 

Tinct. opii. camphoratae, f.3ij 

Tinct. zingiberis, f.3ss 

Tinct. lavand. compos., f.^ss 

Aquam, ad f.^ij. M. 

Take a dessertspoonful every hour or two. 

Large vaginal injections of hot water, and dilatation of the os 
and cervix, are other useful measures. No medicine appears to 
exert a prophylactic effect, unless it is iron in cases of anemia. 

PROF. N. S. DAVIS, M. D., OF CHICAGO. 

Rheumatic Dysmenorrhea. This practitioner has called attention 
{American Practitioner, October, 1877), to a numerous class of 
cases of dysmenorrhea from chronic rheumatic irritation : 

First, the patient should wear constantly good warm under- 
clothes of flannel, eat plain, easily-digested food, drink no kind of 
stimulating drink, and take a full, warm alkaline bath twice a 
week. On getting out of the bath the water should be wiped off 
quickly, and the whole surface briskly rubbed with dry flannel, 
which brings a pleasant feeling of warmth and elasticity. 

Second, medicines should be prescribed on the same principles 
as we would for chronic rheumatic irritation in any other structure 
of the body. Whatever medicines are given, however, must be 
continued faithfully from two to four months, during the interval 
between each menstrual period. 

Treatment during the menstrual week can have no effect beyond 
palliating the suffering of the patient temporarily. To become cur- 
ative it must be extended through the interval, for the purpose of 
so changing the condition of the uterine structure and sensibility 
as to prevent the recurrence of the pain at the next period. 

In the most common class of cases, in which the pain is severe 
and the flow scanty, Dr. Davis has for many years used success- 
fully the following formula : 

49. I£. Tinct. cimicifugae, f.§iij 

Tinct. stramonii, f.^ss 

Vin. colchici rad., f.^ss. M. 

Take one drachm at each meal time in water. 

If, by long continuance or unusual susceptibility, the cimicifuga 
causes dull headache, as is sometimes the case, either the dose 
should be lessened, or the fluid extract of cypripedium may be 



DYSMENORRHEA. 5 3 

substituted in its place. In the same manner, if the colchicum 
should cause disturbance of the bowels, its quantity must be les- 
sened in proportion to the other constituents. 

Another prescription with which he has succeeded in many in- 
stances, especially when the pain and soreness extended to the 
region of the ovaries, is as follows : 

50. fy. Ammonias hydrochlor., §iij 

Tinct. stramonii, f-?ss 

Tinct cimicifugae rac, f.^iss 

Syr. glycyrrhizas, f.^ij. M. 

Teaspoonful three times a day. 

Another useful prescription is : 



51. I£. Acidi salicylici, 






5iij 


Sodii bicarbonatis, 






5ij 


Tinct. stramonii, 








Vini colchici radicis, 




aa 


f.5iv 


Glycerinse, 






f.li 


Aquas, 






f.pij. 


Teaspoonful four times a day 


in water. 







M. 



In connection with their medical treatment, Dr. Davis instructs 
his patients to place themselves in the " knee and chest " position 
for a few minutes three times a day. The hips are high, the knees 
and chest low, thus throwing the uterus by the force of gravity 
into its natural position. Any form of pessary only adds to the 
sufferings of these patients. 

DR. JULIAN S. WOODRUFF, OF SOUTH CAROLINA. 

To meet the severe pain which occurs in some of these cases of 
dysmenorrhea, this writer states, when morphine and atropine are 
combined in solution and injected under the skin for the relief of 
the suffering, their instantaneous effects are truly wonderful and 
charming. An injection of this combination subcutaneously has 
in three minutes extinguished all pain, the patient straightening out 
and laughing and talking. 

DR. HENRY E. WOODBURY, OF WASHINGTON. 

The treatment of this practitioner ( Va. Med. Monthly, Sept. 
1878), is to introduce a very small tent of elm bark into the cervix 
about a week before the menstrual flow commences. After intro- 
ducing the tent, a plug of cotton, to which a cord is attached, is 
passed through the speculum to keep the tent in situ. The plug 



54 DISEASES OF THE OVARIES. 

is then saturated with carbolic acid and olive-oil, or glycerine, in 
the proportion of I to 7. By means of the cords attached to the 
tent and plug, the patient removes them next morning, and uses an 
enema of water and Castile soap. In an obstinate case, a tent is 
used every day up to the time at which the flow should com- 
mence, unless it is established sooner, substituting larger and 
larger ones as the cervical cavity becomes dilated. As soon as 
the tent, on removal, is found to be freely stained with blood, its 
use is suspended until a week before the next period. 

The remedies administered internally are concentrated tincture 
of helonias, fluid extract of ergot, tincture of gelsemium ; or syrup 
of the iodide of iron. The patient commences to take one of 
these three weeks before the regular date of her flow, and contin- 
ues it till this is fully established. She then suspends it for a week 
or ten days, after which she resumes it. Sometimes better results 
are obtained by using two of the above-mentioned remedies alter- 
nately, as the helonias and the iron, or the ergot and iron. A 
gentle current of electricity is passed through the uterus once a 
day for two or three days before the period. This treatment has 
been successfully employed in cases of dysmenorrhea due to sub- 
acute inflammation or displacement resulting in the constriction 
or occlusion of the cervix. 

DR. JOHN WILLIAMS, OF ENGLAND. 

Membranous Dysmenorrhea. This writer (Obstetrical Transactions, 
1877), is of opinion that the inflammation of the internal surface 
of the uterus, often found in these cases, is the result, not the 
cause, of the membranes, but is the result of the membranous 
dysmenorrhea. He does not believe they are the results of 
abortion, as they frequently occur in virgins. The source of mis- 
chief must be looked for in the walls of the uterus itself. The 
membrane is the decidua ordinarily shed as debris at menstruation. 
Dr. Williams thinks there is something wrong in the uterus from 
puberty ; in fact, imperfect evolution. As regards treatment, 
everything should be done to favor the physical development of 
the young girl. Once the condition is established, the only means 
whereby a cure is likely to be effected is electricity, either in the 
form of the continuous current, or by a galvanic stem. 



DYSMENORRHEA. 

RESUME OF REMEDIES. 

* Ammo nice Acctatis Liquor. In painful menstruation, f.3j doses of this 
preparation of ammonia, given every hour when the pains come 
on, will often be found to lessen or wholly dissipate them. 
Barnes recommends : 

52. R. Spiritus aetheris comp., f.3ss 

Liq. ammon. acetat., gtt. xv. M. 

For one dose several times daily. 

Ammo nice Marias. The following is highly recommended by Dr. O. 
Ward, of Tennessee, in the painful dysmenorrhea of the climac- 
teric period : 

53. R. Ammoniae muriatis, 5ij 

Extracti glycyrrhizae, §ss 

Aquas, f.^vj. M. 

A dessertspoonful three times a day. 

Amyl Nitrite has been found of great benefit in spasmodic dysmenorrhea 
by Dr. Mary Putnam Jacobi, especially when supported by 
belladonna, commenced previous to the beginning of menstrua- 
tion {New York Medical Record, Jan. 2, 1875) ; or it may be 
given in one-drop doses in peppermint water every half hour 
(Sell). 

Apiol, in the hands of Dr. Tilt, of London, acts like a charm when given 
in doses of four grains, so soon as the pains of dysmenorrhea 
begin. It of is little use, however, when the dysmenorrhea de- 
pends upon disease of the uterus. 

* Belladonna. In neuralgic dysmenorrhea, Dr. Anstie, of London, re- 
commends (British Medical Journal, August 22, 1868,) the 
extract, as a palliative, in doses of gr. J. He obtained still bet- 
ter results from the hypodermic injection of the sulphate of 
atropia, in doses of gr. T \-^ - gL-, twice a day, and continued for 
several weeks, at once reducing the quantity when marked dry- 
ness of the throat appeared. In constitutions very intolerant of 
belladonna in any form, the acetate of morphia may be advan- 
tageously substituted for the atropia. A belladonna plaster to 
the sacrum is often of benefit ; so also is a suppository of extract 
of belladonna. 

Brominium acts efficiently, according to Barnes, in ovarian dysmenor- 
rhea. 

Camphor. Dr. Dewees regards camphor as a very certain and uniform 
palliative, in doses of gr. x, every one or two hours, until relief 
be obtained. Or the following injection may be given : 

54. R. Camphorae, 3ss-j 

Tincturae opii, f.3j 

Mucilaginis, q. s. M. 

For an enema. 



56 DISEASES OF THE OVARIES. 

Camphor liniment, or ointment, well rubbed into the loins, 
also affords relief. 

Cannabis Indica is sometimes a useful remedy. 

Cimicifuga. The eclectic practitioners speak of this as a most efficient 
remedy in dysmenorrhea, and temporary suppression from cold, 
or where there is a rheumatic diathesis. Phillips endorses this 
statement from his own experience {Mat. Med., 1879). (F. 49.) 

Colchicum is useful in dysmenorrhea connected with a tendency to gout 
or rheumatism. It should be given with blue pill every other 
night ; flannel at the same time should be worn, and exposure 
to cold avoided. (F. 48.) 

Cocculus Indicus. In thin and nervous females, where the discharge is 
scanty, and preceded by paroxysmal griping pains, Dr. C. D. 
F. Phillips {Mat. Med. and Ther., 1879), states that the 
administration of cocculus, commenced a few days before the 
period, will frequently ward off the pains and render the discharge 
natural. The dose is i^ij-x, of a tincture 1-8. 

* Ferri Chloridi Tinctura and Ferri Vinum are both excellent prepara- 
tions in ovarian atonic dysmenorrhea. Sir Charles Locock 
recommends the following formula : 

55. I£. Vini ferri, 

Spiritus aetheris sulphurici 

compositi, aa f.5j 

Mixturae camphoras, f-^ v j- M. 

Take one-fourth part every six hours; 

Crocus Sativus. The saffron is much employed by French practitioners 
in dysmenorrhea, both as infusion and tincture, and also 
locally. The following " cataplasme antispasmodique " is 
highly recommended in painful cases : 

56. E:. Croci contusi, 5hj 

Pulv. camphoras, 

Opii pulveris, aa 5j 

Lini, gviij 

Aquas ferv, q. s. 

Mix the saffron and opium with a little water, and then stir 
this and the camphor into the poultice and lay it warm upon 
the painful uterus. It is especially grateful in "uterine colic," 
or "uterine rheumatism." 

Gossypium. Dr. L. Alexander, of Penna., has found much benefit in 
the following : 

57. fy. Extracti gossypii fluidi, f.^ij 

Extracti ergotse fluidi, 

Tinct. hellebori nigri, aa f.^j. M. 

Teaspoonful every three hours, commencing two or three days 
before the expected attack. 

*Guaiacum is often productive of the greatest benefit. The tinctura 
guaiaci ammoniatce is especially serviceable. In ovarian and 






DYSMENORRHEA. 5/ 

rheumatic forms, it deserves to be called a specific. In chronic 
cases, it should be accompanied by the iodide of potassium. 

Oleum Terebinthince, in doses of gtt.xx, thrice daily, with warm baths, is 
recommended in membranous dysmenorrhea by Trousseau. 

* Opium. Opiates are often best exhibited in the form of enemata. Dr. 
E J. Tilt, of London, recommends a hot linseed-meal poul- 
tice, sprinkled with laudanum, to be applied to the hypogas- 
trium. A single hypodermic injection of morphia, when the 
pain is habitually severe, will often be sufficient at each men- 
strual period. 

*Potassii Bromidum. This sedative is especially valuable in neuralgic, 
ovarian and membranous dysmenorrhea. It should be given in 
large doses, prior to the commencement of the period. 

Potassii Nitras has been found highly serviceable, in doses of gr. xv-xx, 
well diluted with barley water. 

Sinapis. Dr. Ashwell recommends the mustard hip-bath, to be repeated 
three or four times a day, the patient remaining in it for from 
thirty to sixty minutes, or even, if the pain be very severe, until 
faintness is induced. 

Sodii Biboras is of advantage combined with extract of belladonna. 

Stramonium is said to be of marked benefit in the severe form of the 
disease. 

Taraxacum. A half teaspoonful of the extract in a little warm milk 
every night proves useful, by keeping up a healthy action ot 
liver and skin. 

Veratria. Mild veratria ointment, rubbed over the hypogastric region 
twice a day, greatly relieves the pain. 

Viburnum Prunifolium affords often great relief if taken for a few days 
before the menses appear. Dr. E. W. Jenks (Trans, of the 
Amer. Gyn. Soc , 1876), states that in all forms of dysmenor- 
rhea attended with profuse menstruation it is of much value, but 
where the flow is scanty, it does not prove beneficial. It is not 
sufficiently sedative, if given alone, freely to relieve the suffer- 
ings of spasmodic or neuralgic dysmenorrhea ; but it is a valu- 
able adjunct to sedative and antispasmodic remedies. The dose 
is f.5ss-j of the fluid extract, three or four times a day. 

MECHANICAL REMEDIES. 

Galvanism. Dr Wm. B. Neftel (New York Medical Record, Oct. 6, 
1877), gives notes of the cure of two cases of aggravated dys- 
menorrhea of long standing, which had been treated thor- 
oughly but unsuccessfully, by some leading gynecologists, but 
which readily yielded to treatment by the galvanic current. He 
believes that dysmenorrhea is essentially of nervous origin fa 
visceral neuralgia), though it is frequently accompanied by 
structural or mechanical derangements of the womb ; and that 
these derangements are frequently the consequences of the ner- 
vous affection rather than the cause thereof. 

His treatment is as follows : A constant current of consid- 



58 DISEASES OF THE OVARIES. 

ter, discovered by Budge in the spinal cord (situated somewhat 
erable intensity is directed chiefly towards the genito-spinal cen- 
above the lumbar enlargement), and a current of moderate in- 
tensity toward the medulla oblongata. No local treatment of 
the womb is resorted to. 
Rapid Dilatation of the canal of the neck of the uterus in painful men- 
struation resulting from a narrow and restricted condition of the 
uterine canal, has been very successfully applied by Dr. Ellwood 
• Wilson, of Philadelphia {American Gynecological Transac- 

tions, 1877). This he accomplishes by means of an instrument 
designed for the purpose. 



MENORRHAGIA AND METRORRHAGIA. 

PROF. ROBERT BARNES, OF LONDON, 

Says in all cases of hemorrhage from the uterus, obtain and main- 
tain a patulous condition of the cervical canal. This, of itself, 
often arrests the bleeding. Remove everything in the shape of a 
foreign body, as clots, retained ova, membranes, or placenta. To 
do this, one or two fingers may be passed in to break them up. 
Hemostatics may be introduced by means of a swab of cotton 
wool, twisted on a roughened probe ; or where, by reason of the 
narrowness of the canal, this is impracticable, injections or solid 
styptics may be used. The best way is by inserting small bits of 
sponge in a tube made like the uterine ointment positor, and satu- 
rating this with the styptic. The tube is then passed into the 
uterus, and pressure of the piston squeezes out the fluid, drop by 
drop, upon the bleeding surface. This failing, the styptic must be 
injected boldly. 

In passive hemorrhage, the general vascular tension, the in- 
creased action of the heart, and the determination of blood to the 
pelvic organs, must be moderated. The most useful agents here 
are digitalis, aconite, bromide of ammonium or potassium, some- 
times opium, ipecacuanha, chloral, salines, as acetate of ammonia, 
nitrate of potassa. Cold is often useful. Ice in the vagina or 
cold water injections should always be tried early. 

Position is important ; keep the pelvis above the level of the 
body. 

Saline purgatives especially, operate with advantage. Internally, 
the most useful are turpentine in capsules, ergot in fluid extract or 
powder, or ergotine, tincture of hamamelis in five or ten drop doses 
every three or four hours, quinia, strychnia, sulphuric or phos- 
phoric acid, tannic or gallic acid, acetate of lead, the vinca major, 
Indian hemp, ipecacuanha. All failing, styptics locally must be 
used. The after-treatment does not at first require iron ; this only 
adds fuel to the fire ; the system requires, first, salines, these serve 
better to replenish the exhausted circulating fluid. They subdue 
vascular excitement, allay fever, calm nervous irritability, improve 
the secretions, and prepare the way for iron and other tonics. The 

(59) 



60 DISEASES OF THE OVARIES. 

best form of saline is the freshly prepared acetate of ammonia ; to 
this may be added a sedative, as Battley's solution, and sometimes 
digitalis or aconite. Later, hamamelis, ergot, quinine, mineral 
acids, and a decoction of bark, and later still, iron. The best 
forms are the citrate, acetate or chloroxide in an effervescent form, 
or the dialyzed iron, at first in small doses to feel the way. Sleep 
is of signal service, opium with the saline, or as the compound 
opium pill in five-grain doses, or as pulv. ipecac, comp., ten grains. 
If not well borne, we have a precious resource in chloral, in 
scruple doses. 

PROFESSOR T. GAILLARD THOMAS, NEW YORK. 

This author says that in cases of menorrhagia the patient should 
be kept perfectly quiet upon her back ; cloths wrung out of cold 
water should be laid over the uterus, vulva and thighs ; cold acid- 
ulated drinks should be given freely; and the injection of all warm 
fluids strictly interdicted. In addition, the apartment should be 
kept cool, the nervous system quieted by opium or an appropriate 
substitute, and all conversation prohibited. In mild cases this 
may suffice, but in severe ones it will not. Then the speculum 
should be introduced, a sponge-tent passed into the cervix, and 
the vagina filled with a tampon. This will rarely fail. But in 
certain cases, as, for instance, those of cancer of the neck, the tent 
will not be admissible. Under these circumstances, a soft sponge 
or wad of cotton should be saturated with a solution of persul- 
phate of iron, laid upon the cervix, and the tampon placed against 
it; or a small linen bag may be filled with powdered alum, placed 
in contact with the cervix, and held in place by a tampon ; or two 
drachms of tannin may be left free against the part. To these 
means almost all cases will temporarily yield, more especially if 
the use of the tent is admissible. 

Where the menorrhagia is due to a fungous degeneration of the 
intra-uterine membrane, the curette is a most valuable resource ; 
or the lining membrane of the uterus may be modified by ener- 
getic agents, as nitric acid, tincture of iodine, nitrate of silver, etc. 

In very obstinate cases, change of climate will often prove of 
decided benefit. 



MENORRHAGIA AND METRORRHAGIA. 6 1 

PROF. ROBERTS BARTHOLOW, M. D., PHILADELPHIA. 

When monorrhagia is the result of impoverished state of the 
blood, iron is the most appropriative medicament. It may be com- 
bined with arsenic. 

Gallic acid is very effective, as in the following formula : 

58. 3. Acidi gallici, 3ss 

Acid, sulphur, dil., f.5j 

Tinct. opii deod., f.3j 

Infus. rosae comp., f.^iv. M. 

A tablespoonful every four hours, or oftener. 

When there is a large spongy uterus, ergot is indicated. When 
caused by ovarian excitement, bromide of potassium will promptly 
relieve. 

Ipecacuanha possesses very valuable anti-hemorrhagic powers ; 
it should be frequently repeated. 

59. I£. Ext. ipecac, fluidi, f.5ij 

Ext. ergotse fluidi, f.3iv 

Ext digitalis fluidi, f.3ij. M. 

Thirty minims to a teaspoonful at a dose, as required. 

In debilitated and relaxed subjects, menorrhagia may be relieved 
by determining an afflux of blood to the uterine system. Iron and 
aloes may be here associated. But the latter would be contra- 
indicated where there already existed congestion of the pelvic 
viscera. 

EDWARD JOHN TILT, M. D., LONDON. 

This writer lays much stress on the importance, in severe cases, 
of placing the head on a level with the body. Sedatives are always 
beneficial. The bromide of potassium or of ammonium has been 
known to check the tendency to menorrhagia. 

In many cases, damaging blood loss may be checked by the ex- 
hibition of full doses of the liquid extract of ergot and the tinc- 
ture of digitalis, f.5ss three times a day, as: 

60. I£. Tincturse digitalis, 

Extracti ergotse fluidi, aa f.5iij 

Aquas destillatae, ad f.§vi. M. 

The sixth part to be taken three times a day for three days. 

While giving these remedies, a two grain opium suppository 
should be passed into the rectum once a day, even if there be no 



62 DISEASES OF THE OVARIES. 

pelvic pain, for opium has often helped to quell blood-flow. In 
any case, it is well to commence with small doses of ergot and 
digitalis a few days before the menstrual period is due. 

PROF. GRAILY HEWITT, M. D., LONDON. 

The treatment must of course in all cases have reference to the 
exciting cause of the profuse flow. Flexion or congestion of the 
uterus is frequently present. It must receive attention. 

The external employment of baths is of the greatest service, 
especially cold hip-baths and sponge-baths. Cold to the spine, by 
means of ice-bags, has proved of service. Injections of cold or 
iced water into the rectum is a valuable means of arresting the 
flow of blood in bad cases. 

Dr. Hewitt believes that styptics taken internally are frequently 
found very serviceable ; of them, he considers the most efficient to 
be matico in combination with tincture of iron, or the latter alone 
in large doses, TTLxxx-xl. Opium has been highly extolled, but 
does not appear to be adapted for chronic cases. 

Where the discharge is exhausting, stimulants and nourishment 
should be freely administered in small quantities at frequent in- 
tervals. 

PROF. WILLIAM H. BYFORD, M. D., OF CHICAGO. 

This practitioner, in the Transactions of the International Med- 
ical Congress, 1876, discusses in considerable detail the treatment 
of metrorrhagia. 

In the palliative treatment, isolation, quietude, and recumbency, 
are very important cautions to be enjoined. Plain food, cool 
clothing, and general hygienic rules, are indispensable. In regard 
to drugs, Dr. B. has derived considerable advantage from astrin- 
gents proper. The most generally applicable agent is ergot; but 
it will usually fail when the flow is venous, as in retroversion, 
pelvic infraction, tumors, etc. When there is much pain in the 
pelvis, and a dry state of the skin, opium and ipecacuanha are 
very serviceable. When vascular and nervous excitement is 
prominent, lobelia, gelsemium, digitalis, aconite, and veratrum vir- 
ide, are all of use. 

These measures failing, we must resort to either mechanical or 
chemical means. The former is represented by the tampon ; the 
latter by powerful hemostatics. They may be all advantageously 



MENORRHAGIA AND METRORRHAGIA. 63 

combined, as in the plan proposed by Dr. Marion Sims. His 
hemostatic is — 

61. ty. Liquoris ferri subsulphatis, f.^ss 

Aquae, f.Jj. M. 

The finest cottonwool is saturated with this, and then submitted 
to moderate pressure and dried for use. Its application is made 
by wrapping a sufficient quantity around a long, small piece of 
whalebone, and introducing it into the cavity of the uterus, when 
the cotton is detached and left there. If the hemorrhage is 
moderate, one such piece will suffice ; if severe, it will be necessary 
to stuff the uterine cavity full. Strong thread can be attached to 
the cotton to withdraw it when necessary. From twelve to 
twenty-four hours is as long as it should remain. 

In the intermenstrual period, curative measures should be 
resorted to, as alteratives, tonics and derivatives. Muriate of 
ammonia will be found especially valuable. When debility is 
present, among the very best remedies is — 

62. R.. Hydrargyri chloridi corrosivi, gr. y^-xV 

Tinct. cinchonas composili, f.3j. M. 

This amount thrice daily. 

Iodine, iodide of potassium, and iodide of iron, are also effi- 
cient. A beneficial derivative measure is dry cups over the sacrum 
often repeated. The cups should be large, and allowed to remain 
for an hour or more. 

M. PANAS, M. D., OF PARIS. 

Among the various manipulative measures used in severe 
metrorrhagia, preference is given by this writer to plugging the 
cavity of the neck of the womb, which has several acvantages 
over plugging the vagina in such cases. It stops the blood more 
effectually, the patients bear it better, and there is less chance of 
putrid absorption. The plan adopted by M. Panas consists of 
introducing into the cavity of the uterine neck a pledget of cotton 
wool, rolled up to about the thickness of a goose-quill, and steeped 
in a solution of the perchloride of iron of the French Codex, to 
which is added one part of water, to prevent its caustic effects. 

This being done, he introduces a ball of cotton wool and places 
it in the posterior cul-de-sac of the vagina, where it not only forms 
a support to the uterine plug, but it absorbs any liquid that may 



64 DISEASES OF THE OVARIES. 

escape through it, and thus protects part of the vagina (which is 
covered with the peritoneum) from the corroding effects of the 
perchloride of iron and the acrid discharges from the womb. 

DR. EMIL DILLENBERGER, VIENNA. 

The treatment of menorrhagia according to the Vienna school 
comprises rest, horizontal position with the pelvis elevated, low 
diet, and cooling drinks, such as : 

63. I£. Acidi tartaric!, gr.x-xxij 

Syrupi aurantii floris, f-3vj 

Aquae, f.gxv. M. 

For drinking. 

64. I£. Tamarindi, §j 
Fiat decoctum librae unius, 

(Acidi sulphurici aromatici, f-3j-ij) 

Syrupi rubri, f.^ss-j. M. 

For drinking. 

65. I£. Acidi sulphurici aromatici, f.3ij 

Syrupri rubri, f.§j. M. 

One to two teaspoonfuls in a glass of water as a drink. 

These directions and prescriptions, together with pure air, only 
moderately warmed, in the room, are some of. the most important 
points which alone will often restrain rather free bleeding. 

When there is passive hemorr/iage, use cold dressings, injections 
of cold water, or the following astringents : 

66. fy. Aluminis, 3ij-ivss 

Aquae, f.^iv. M. 

For vaginal injections. 

67. I£. Acidi tannici, 5ss-iv 

Aquae, f.^xv. M. 

For vaginal injections. 

68. ^. Zinci sulphatis, gr.x-xxxiv 

Aquae, Oj. M. 

For vaginal injections. 

69. ~fy. Catechu, 3ij 

Aquae, f.§xv. M. 

For vaginal injections. 

70. I£. Extracti krameriae, 3ij 

Aquae, f.^xv. M. 

For vaginal injections. 



73- !£• Extracti ergotae fluidi, 


nixx-xl 


Syrupi acaciae, 


f.3U 


Syrupi aurantii florum, 


f.?ss 


Aquae, 


f.liij. 


One tablespoonful four times a day. 




74. I£. Extracti krameriae, 


gr.vj-xx 



MENORRHAGIA AND METRORRHAGIA. 65 

Plugging the vagina is also an effectual remedy. 
Among internal remedies, those that have generally shown 
themselves the best are : 

71. fy. Ferri chloridi, gr.xvj 

Tincturae opii, gtt.x 

Syrupi tolutani, f.^ij 

Aquae, f.fvj. M. 

A tablespoonful every one to two hours. 

72. 3. Pulveris ergotae, 

Sacchari albi, aa gr.xxxiv 

Olei cinnamomi, gt.j. M. 

Divide into six doses. One powder every five minutes. 



M. 



Alu minis, 

Sacchari albi, aa gr.xxij 

Olei cinnamomi, gt.j. M. 

Divide into six powders. One powder every two to five hours. 

7$. J£. Aluminis, gr.xxxij 

Tincturae cinnamomi, f.5U 

Syrupi aurantii corticis, f.^ss 

Aquae cinnamomi, f.§iv. M. 

One tablespoonful hourly. 

RESUME OF REMEDIES. 

Achillea Millefolium, the yarrow, has beneficial properties where the 
excessive flow depends on atony of the organs. 

Acida. The mineral acids internally have been familiar to the profession 
for many years as remedies for excessive flowing, but their 
efficacy has been doubted of late years. (See F. 58, 65). 

A lumen often proves successful in controlling the hemorrhage. Dr. E. J. 
Tilt, of London, says that in uterine hemorrhage, alum, in 
solution with sulphuric acid, is the first remedy to try. 

Ammonii Bromidum. In cases of too frequent menstruation, not spec- 
ially connected with menorrhagia, but rather with abnormal 
activity of the genital system, Dr. J. R. Black, of Ohio, has 
found decided benefit from this drug, gr. x, four times daily, 
beginning at least a week before the expected molimen {Half 
Yearly Compendium, July, 1879). 

Argenti Oxidum is an efficient remedy in menorrhagia. More than three 
grains daily should not be given. 

Arseniosum Acidum. Fowler's solution is said to check uterine hemor- 



66 DISEASES OF THE OVARIES. 

rhage, given at first in the dose of ttjx-xx, and repeated in tiix 
doses every twenty minutes until the discharge ceases. This 
remedy must not, of course, be pushed too far. 
Berberice Sulphas. Dr. R. H. Andrews, of Pennsylvania {Trans, of the 
Pa. State Med. Soc, 1877), reports very satisfactory results with 
this drug in cases of profuse exhausting menstruation. He 
prescribed the remedy as follows : 

76. I£. Berberiae sulphatis, 9j 

Sacchar. albi, 3iss. 

Make 12 powders. 

One of these powders is directed to be taken when the flow is 
very free, or if not free, in three or four days after the menses 
have appeared ; repeated in four or eight hours, according to 
indications. The effects of such an administration of the 
remedy are, a cessation of the profuse flow, diminution in the 
length of the period, and in a measure curative of the disease. 

Borax is employed by some practitioners. (See under Ergotd). 

* Cannabis Indica. Dr. Churchill, of Dublin, obtains from the tincture 
of Indian hemp, in doses of gtt v-x, thrice daily, remarkable 
success in the treatment of menorrhagia and uterine hemor- 
rhage. Dr. Thomas, of New York, pronounces it one of the 
best agents in this disease at our command. 

Catechu may be used in passive hemorrhage. (F. 69). 

Cimicifuga. Dr. Ringer, of London, says this remedy will certainly 
arrest menorrhagia, though he regards it as inferior in this 
affection to the bromide of potassium 

Cinnamomum is a grateful stomachic, and nearly always of value in ute- 
rine hemorrhages. It may be given as tincture or in the pow- 
der, 3]. at a dose. 

Digitalis is useful in menorrhagia and other forms of uterine hemorrhage, 
unconnected with organic disease. Dr. E. J. Tilt, of London, 
employs the following : 

77. I£. Tincturae digitalis, f.5ij 

Acidi hydrocyanici diluti, nixxx 

Morphias acetatis, gr.j 

Aquam, ad f.^vj. M. 

A dessertspoonful every two or three hours. 

Dr. W. H. Dickinson recommended the infusion gj-iss. 
*Ergota, though not equally beneficial in all cases, is a useful remedy in 
menorrhagia. Dr. Waring-Curran states {Medical Press, Nov. 
17, 1869), that it proves most useful in that form of menorrha- 
gia which occurs in women of a scrofulous habit, who suffer 
from constipated debility, and in whom leucorrhcea exists as a 
consequence of previous hemorrhage. He gives freshly pre- 
pared infusion of ergot and borax in menorrhagia from obstruc- 
tive cardiac disease, in that associated with a diseased portal 



MENORRHAGIA AND METRORRHAGIA. 6j 

system, in that consequent upon a scorbutic state of the system, 
and in genuine menorrhagia (i. <?., an increase of the catamenia, 
continuing for a lengthened period, and returning before the 
proper period, without organic lesion). He finds it has little 
or no effect in menorrhagia dependent upon ulceration of the 
os, the presence of polypous growths or other tumors, or in 
that arising from retroflexion of the uterus. Ergotin, subcu- 
taneously, should not be neglected. Atthill prescribes it in 
the form of infusion, and if symptoms of ovarian irritation exist 
adds bromide of potassium in full doses. If anemic, ten drops 
of tincture of iron with three to five drops of solution of strych- 
nia to each dose of ergot. The strychnia increases in a marked 
degree the action of the ergot. 

Ferrum. The preparations of iron should be given when there is defect- 
ive assimilation and nutrition. Butmust not be exhibited in 
a routine manner. *~ There are cases of menorrhagia associated 
with pallor and debility, where the usual compound of iron and 
extract of ergot is not so useful as a non-chalybeate treatment. 
In these cases it is not any imperfection in the process of blood 
manufacture which is to be remedied, for the blood is made 
rapidly and quickly, only, to be lost at each menstrual period. 
It is here desirable rather to limit the rapidity of the blood for- 
mation, so that when the severe vascular turgescence of the 
menstrual period comes, it will not find the blood vessels too 
distended with blood. This will lead to diminished catamenial 
loss, and so the blood- waste will be economized. 

*Gallicum Acidum was much employed by the late Sir J. Y. Simpson, of 
Edinburgh, in atonic menorrhagia. He gave it in doses of gr. 
x, xv or xx daily, and continued its use during the intervals, as 
well as the period of discharge. Dr. E. J. Tilt, of London, 
while testifying to its value as an astringent in many cases, finds 
that it often fails when the hemorrhage depends upon organic 
lesions. Dr. William Goodell gives it in doses of gr. xx-xxx 
every two hours, in syrup or molasses. Dr. T. H. Tanner pre- 
scribes : 

78. I£. Acidi gallici, gr.xv-xxv 

Acidi sulphurici aromatici, tUxv-xx 

Tincturae cinnamomi, f.5ij 

Aquam destillatam, q. s. ad f.^ss. M. 

For one dose. Mix with two or three tablespoonfuls of water, 
and take every few hours, in profuse menorrhagia, until the 
bleeding ceases. 

Dr. Atthill gives it with ergot, ten grains of each. 

Hamamelis has been recommended, in doses of a few drops of the fluid 
extract. Its virtues are questionable. 

* Ipecacuanha, in full emetic doses, is often productive of the best results. 
Under the use of gr. xx of the powdered root, in the evening, 
followed by an acidulated draught in the morning, the discharge 
frequently ceases in twenty-four hours ; if a relapse occurs, a 



68 DISEASES OF THE OVARIES. 

repetition of the emetic seldom fails to make the cure perma- 
nent. Dr. Tyler Smith thus explains its action in these cases; 
by its emetic power, it excites contraction of the abdominal 
muscles and compression of the uterus, which may, in turn, re- 
excite some amount of uterine reflex action ; but beyond this, 
it appears to have a special action upon the uterus, increasing its 
contractile power beyond what could be imagined to occur from 
the merely secondary effects of vomiting. Ipecacuanha thus ap- 
pears to influence the medulla oblongata and the lower medulla 
spinalis. This double action upon the extremities of the spinal 
centre is very extraordinary. 
Krameria is particularly useful in menorrhagia occurring about the usual 
time of the cessation of the menses. Dr. Dewees employed the 
following formula : 

79. I£. Extracti krameriae, 5ij 

Pulveris rhei, 5ss 

Syrupi, q. s. M. 

Divide into forty pills, and order two thrice daily. 

Magnesia Sulphas is recommended by Dr. Grailly Hewitt, of London, 
who found a mixture containing very small doses of this salt, with 
a little dilute sulphuric acid and syrup, very useful during the 
time of the catamenial flow. 

Matico. The pounded leaves, made into a paste and introduced into the 
vagina, are said to arrest the hemorrhage, after the failure of a 
strong solution of nitrate of silver. 

Plumbi Acetas often succeeds in severe cases, when given in enema : 

80. ^. Plumbi acetatis, gr.xv-xx 

Tincturas opii, 1*1x1 

Mucilaginis, f.gij. M. 

For enema. 

In mild cases, the internal administration of sugar of lead and 
opium is usually successful. Dr. Workman, of Canada, gives 
it in doses of gr. xxx, repeatedly. 
*Potassii Bromidum is a favorite remedy of Dr. Ringer, of London, who 
lays down the following rules for its administration in menor- 
rhagia : If the loss of blood occurs only at the natural menstrual 
period, it will be sufficient to begin the medicine about a week 
before the discharge is expected ; and when this has for a time 
ceased, it should be discontinued till the next attack is about to 
begin. If, on the other hand, the loss of blood occurs every 
fortnight, or oftener, it should be given without any intermis- 
sion, till the disease is well controlled; and when the discharge 
has keen brought to its right period and amount, a ftw doses 
should be given for a short time before each monthly period. 
It has less control over uterine hemorrhage due to tumors of the 
uterus than ergot and other remedies. In ovarian menorrhagia, 
indicated by tenderness of the ovaries, Dr. Alfred Meadows 






MENORRHAGIA AND METRORRHAGIA. 69 

has found no drug which possesses so great power as the 
bromide : 

81. R. Potassii bromidi, gr.xxx 

Syrupi ferri bromidi, 3j. M. 

This amount in water thrice daily. Locally a pessary contain- 
ing conia, gr.j, atropia, gr. T l .j, in the vagina every night. 
{British Medical Journal, July 12, 1879.) 

Quinice Sulphas. In malarious districts, full doses of quiniae are often 
the only remedial means efficient or required in this form of 
hemorrhage. Dr. Barnes always uses it in hemorrhage from 
sub-involution. 

Sulphuricum Acidum Dilutum is a favorite remedy with some. 

Savina. Phillips has derived great benefit from gtt.v-x of the tincture, 
in a tablespoonful of cold water every half hour, in menorr- 
hagia. Aran considers it one of the most valuable agents in 
hemorrhage from an atonic condition of the uterus. 

* 1 annicum Acidum, alone or combined with a small portion of dilute 
nitric acid, has often the happiest effects. Dr. Robert Burns, 
of Phila., employs : 

82. fy. Acidi tannici, 

Zinci sulphatis, aa 5) 

Glycerinas, f.§j. M. 

Wet cotton with this, and apply to the interior of the uterus. 

lerebinthincz Oleum. A prescription recommended by Dr. E. J. Tilt, is : 

83. ]£. Olei terebinthinae, f.^ss 

Tincturae capsici, f.3ss 

Tincturae ergotae, f.3j 

Tincturae lavandulae composite, f.^ij. M. 

In cases of uterine hemorrhage, give from half a drachm to a 
drachm of this mixture in milk, after shaking the bottle. In 
severe flooding after parturition, from half an ounce to an 
ounce may be given in plenty of milk, with good results 

Urtica. The nettle in infusion is a popular remedy. 

Viburnum Prunifolium is peculiarly applicable in monorrhagia depending 

wholly upon systemic causes, as phthisis, diseases of the heart or 

liver, malaria, etc. It is also beneficial in that occurring at the 

menopause. 
Viscum Album. The mistletoe has been recently commended in menorr- 

hagia by some observers. 
Zinci Oxidum is highly spDken of, by Prof. A. R. Simpson, of Edinburgh, 

in doses of gr ij thrice daily. 
Zinci Sulphas, in doses of gr. j-ij in pills, thrice daily, is often useful in 

the atonic forms of menorrhagia. 



JO DISEASES OF THE OVARIES. 

VAGINAL INJECTIONS. 

Alumen. Dr. E. J. Tilt, of London, orders, in purely atonic cases of 
menorrhagia, the following vaginal injection : 

84. ^. Aluminis, 5j 

Decocti quercus albae, Oj. M. 

This injection is inadmissible if inflammatory symptoms be 
present. 

Ferri Chloridi Tinctura, with equal parts of water, has been injected with 
success. 

Galla, Decoction of galls (E}}(, aquae Oj), daily injected into the vagina, 
warm or cold, according to the feelings of the patient, is occa- 
sionally useful. 

Quercus Alba. The decoction, with or without alum (5j, ad decocti 
Oj), is a serviceable and safe vaginal injection. 

Sponge Tents. Dilatation of the cervix by sponge tents has been found 
by Dr. G. H. Lyman and other gynecologists greatly to reduce 
the flow of blood in numerous cases of metrorrhagia (Amer. 
Gynecol. Trans., 1877). He believes that the real cause of the 
persistent hemorrhage is in many cases some peculiar condition 
of the cervix, which strangulates the circulation, the removal of 
which condition promptly arrests the flow. 

Heat. Vaginal injections of water as hot as it can "be borne prove of 
great service in many cases. Rubber bags or bottles filled with 
hot water, or a hot tile plate or brick wrapped in flannel, 
applied to the sacrum, are likewise efficient. Bags of sand or 
salt may be heated and applied in the same manner; they 
should in all cases be hot, and not merely warm. Dr. John 
Chapman believes a temperature of 115 Fah. to be sufficient 
in nearly all cases, 

Cold may be applied by cloths or ice bladders to the uterus, vulva, and 
thighs ; or Chapman's ice-bags to the sacrum ; or by injec- 
tions of iced water into the rectum or vagina. Dr. T. G. 
Thomas recommends that cold drinks only should be used, and 
the ingestion of all warm fluids strictly forbidden. In obstinate 
cases a change of residence from a warm to a cold climate often 
accomplishes a great deal of good. A lump of ice inserted into 
the vagina was the only hemostatic employed by Madame 
Recamier. Dr. L. S. Oppenheimeir, of Louisville, speaks 
strongly in favor of the cold hip-bath (Louisville Med. News, 
Aug. 3, 1878). He says: I have seen cases of metrorrhagia 
lasting for over a month, permanently cured by this method 
alone in a few days. The mode of administration of these 
baths is not that of an ordinary hip-bath, but differs in that the 
water must be en c our ant. The stream should be so gentle at 
first as not to be felt by the patient, and gradually increased in 
force. The whole bath should not last longer than two minutes 
on the first day, then upon each succeeding day the length of 
time increased one minute. 



HYSTERIA. 

Although hysteria is not absolutely confined to the female sex, 
its vast preponderance among them, and its very frequent, in fact 
almost invariable connection with some abnormal state of the re- 
productive system, renders it, for most practical purposes, one of 
the diseases of women, and for that reason we shall treat of it 
here. 

PROF. AUSTIN FLINT, M. D., NEW YORK. 

Of medicinal agents, asafcetida and valerian stand first. The 
bromides may often be prescribed with advantage ; but they, like 
all narcotics and stimulants, must be continued for a short time 
only, as hysterical patients very easily drift into their habitual use. 

The removal of associated disorders of any kind is an impor- 
tant part of the treatment. Especially should all ovarian and 
uterine disease receive immediate attention. Ungratified sexual 
desire as a causative agency has been overrated ; over-indulgence 
in sexual pleasure is more often a cause than continence. The 
propriety of advocating matrimony is doubtful. A very large pro- 
portion of hysterical cases are anemic, and anemia promotes hys- 
teria, as it does other neuroses. To effect a restoration of the nor- 
mal state of the blood, is generally a prominent indication. 

The moral management of such cases always calls for the exer- 
cise of delicacy, tact, and firmness. 

PROF. WILLIAM AITKEN, M. D., EDINBURGH. 

The following directions are given by this author as to what 
may be done during a fit of hysteria : Everything tight about the 
patient's person should be loosened. The window should be 
opened and the cold air allowed to blow over her. The horizontal 
posture on a bed or the floor should be secured. This being done, 
many modes of further proceeding may be followed. Bleeding is, 
in all cases, of doubtful efficacy. When the jaw is locked, the 
following enema (recommended by Dr. Wood) may be used : 



M. 



. ty. Asafcetidae, 


5ij 


Aquae. 


Oss. 


3 be beaten up with the yolk of an egg. 




(7i) 





72 DISEASES OF THE OVARIES. 

Or, what is still better, 

86. fy. Olei terebinthinas, f.^ss. 

To be mixed with the yolk of an egg, and then added to half a pint of 
water. 

Another remedy is to fill the month with salt. But that which 
supersedes all others, and is unquestionably the best, is a good 
drenching with cold water. If the patient lie on the bed, the head 
should be drawn over its side, and a large quantity of water 
poured on it, from a considerable height, out of a pail, jug, or other 
large vessel, and directly over the mouth and nose of the patient, 
so as to stop her breathing and compel her to open her mouth. 
This practice is generally introduced into hospitals, and until it 
was adopted, it was not unusual to see three or four patients in 
hysteria in the same ward and at the same time. Under this prac- 
tice, however, a hysterical case is rare, and the fit seldom occurs 
twice in the same person, and never becomes epidemic. 

DR. A. B. ARNOLD, OF BALTIMORE. 

This writer remarks {Med. and Surg. Rep., August, 1879), that 
every physician has some favorite combination from this class of 
drugs, which the hysterical patient is recommended to keep on 
hand for emergencies. The following he has found to answer the 
purpose very well : 

87. $. Ext. valerian, fl., f.gj 

Ext. sumbul. fl., f.^ss 

Tinct. castorei, f.5vj 

Spt. ether, chloric., 

Syr. aurant. cort., aa f.Siij. M. 

One teaspoonful, frequently repeated. 

THOMAS KING CHAMBERS, M. D., LONDON. 

88. R. Acidi muriatici diluti, f.^iss 

Aquae calefactae, (95 F.) C.xxx M.. 

For a bath. This tonic warm bath is to be used once a day, in order 
to prepare the patient for a showei' bath twice a day. 

Shower baths, in hysterical cases, are highly recommended by 
Dr. C. The making up the mind to the shock of a cold shower 
bath is a capital exercise of the will. Such baths have also a good 
influence by arterializing the cutaneous circulation, driving the 
venous blood home to the heart and lungs. 



HYSTERIA. 75 

Our author rings the changes upon the following prescriptions 
in the treatment of this disease : 

89. ty. Pilulae asafcetidae, No. xxx. 
Three to be taken thrice daily. 

90. ty. Spiritds ammonias fcetidae, f.^iij. 
A teaspoonful in water three times a day. 

91. $. Tincturae castorei ammoniatae, 

Aquae fceniculi, aa f.§ij. 

A dessertspoonful in water thrice daily. 

92. fy. Pilulag galbani compositae, No. xxx. 
Two thrice daily. 

s 

93. I£. Zinci valerianatis, 5j 

Syrupi, q. s. 

Divide into twenty pills. One to be taken three times a day. 

PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 

94. I£. Auri et sodii chloridi, gr.v 

Tragacanthae, 5j 

Sacchari, q. s. M. 

Divide into forty pills. Order at first one of these pills to be taken an 
hour after dinner, and another an hour after supper. Afterwards 
order two pills to be taken at these hours, and gradually increase 
dose up to eight pills daily. 

Dr. N. speaks of this preparation as a nervine of great efficacy 
in hysteria. He has made use of it with signal effect in many 
cases where there was no indication for the local treatment of 
uterine disease, or else where the hysteric symptoms persisted, 
although the local uterine affection had been cured. 

DR. F. T. PORTER, OF DUBLIN, 

Has found (Dublin Journal of Medical Science, April, 1874,) the 
bromides to act most injuriously in hysterical cases, deranging 
digestion, weakening the heart, and retarding menstruation. He 
prefers the valerianates, hemlock, and lupulus. When there is 
spinal tenderness, he employs iron. When plethora is present, as 
evinced by increased temperature, vascular relaxation and con- 
tracted pupil, he considers belladonna a most efficacious remedy. 

DR. S. WEIR MITCHELL, OF PHILADELPHIA, 

Believes that mimetic hysteria can be cured almost unfailingly; 
but to accomplish this the patient must be isolated from the cares 



74 DISEASES OF THE OVARIES. 

and sympathy of home, and placed in an institution under strict 
surveillance. 

Valerianate of zinc in 12 gr. doses thrice daily is a valuable 
sedative. If there is marked anemia, the patient should be put to 
bed and fattened by the use of massage, electricity, and excessive 
feeding. 

EDWARD JOHN TILT, M. D., LONDON. 

95. fy.. Tincturae castorei, f-5iij 

Spiritfls lavandulae compositi, f.Syj 

Aquam camphorae, ad. f.^vj. M. 

A tablespoonful two or three times a day when cerebral symptoms 
and hysterical phenomena are marked. 

The therapeutical indications in the treatment of hysteria are : 
1st. To blunt the sensitiveness of the nervous system by sedatives 
and antispasmodics, and to strengthen it by metallic and other 
tonics, and by hygiene. 2d. To cure all diseases of the sexual 
organs, and save the nervous system from visceral irritation, by 
good hygiene at menstrual periods; or by marriage, when the 
sexual organs crave their legitimate satisfaction. 

GERMAN PHARMACOPOEIA.. 

96. I£. Tincturae asafcetidae, f.5iv 

Tincturae castorei, f-3jij 

Tincturae opii, f.5j. M. 

From fifteen to thirty drops, by the mouth or in enemata, twice or three 
times a day, in the hysterical attacks of dysmenorrhea. Bitter 
drinks and preparations of iron in the intervals of the attacks, if the 
patient be anemic. 

RESUME OF REMEDIES. 

sEther. Nothing, according to Stille, so distinctly moderates the par- 
oxysms of this disease as the inhalation of ether. Those who 
have found the spasms aggravated by a certain degree of etheri- 
zation have not administered a sufficient quantity of the vapor. 
If persisted in, it would undoubtedly have put an end to the fit. 

Allium. The smell of bruised garlic will sometimes promptly terminate 
a hysterical paroxysm. 

Atropia. In hysterical trismus, nothing acts so well as hypodermic in- 
jections of this alkaloid. Full doses are required. 

Auri et Sodii Chloridum is prescribed by Dr. Niemeyer. (F. 93.) 

Aloes. The pill of aloes and asafcetida is very serviceable in the con- 
stipation of hysteria. 

* Ammonium. The carbonate, the aromatic spirits, the foetid spirit, the 
valerianate, and other preparations, are much used and of great 
value. 



HYSTERIA. 75 

Amhemis. A wineglassful of the infusion of chamomile may be given 

with advantage thrice daily. 
*Asafcetida is a most valuable medicine in this disease. It may be given 

alone, or combined as directed in the following form : 

97. I£. Tincturae asafcetidae, 
Tincturae castorei, 

Tincturae Valerianae ammoniatae, aa f.5ij 
Aquae camphorae, f-3 v U- M* 

Dose. — One or two tablespoonfuls every hour. Asafaetida may 
also be given, in the form of an enema. (F. 95.) 

Aurantii Flores. Orange-flower water is much used and valued in 
France. It is an elegant stimulant and antispasmodic, in doses 
of from one to twc^ fluid ounces. 

Cajuputi Olewn internally is often of benefit. 

Camphor a is a very serviceable remedy, either alone or in combination 
with asafcetid aor opium. 

Cannabis Indie a is sometimes useful. 

Chloroform inhalation is highly praised by Dr. Brown-Sequard and Dr. 
Graily Hewitt, in severe and prolonged hysterical parox- 
ysms. Internally it may be given with ammonia or asafoetida. 
A liniment of chloroform often speedily relieves hysterical pain 
in the side. 

Cupri Sulphas, in small doses, long continued, is recommended by Sir B. 
Brodie, in obstinate hysteria. 

Cusparia Cortex. The infusion is an eligible light tonic in hysteria. 

Ferrum is indicated in hysteria associated with anemia. It may be given 
combined with valerian and other antispasmodics. 

Galbanum sometimes agrees better than asafoetida, and may produce 
equally favorable results, particularly in cases associated with 
disordered uterine functions. A galbanum plaster over the 
sacrum often affords relief. 

* Lavandula is sometimes an effectual remedy. 

Lupulin has been recommended in chronic hysteria, attended with mor- 
bid vigilance, in doses of ten grains every six hours. 

Moschus, in doses of gr. x-xv thrice daily, is a valuable remedy, particu- 
larly when the surface is pale and the pulse languid. 

Potassii Bromidum is sometimes a useful sedative in hysteria. Its use 
was suggested in this disease by Sir C. Locock. 

Ruta. From two to five drops of the volatile oil, on sugar, is a popular 
remedy; so also is the infusion of rue. 

^Santonin sometimes proves useful in revealing the true cause of the hys- 
terical symptoms, viz., worms in the intestinal canal. 

*Spiritus ALtheris Nitrosi is often very effectual in relieving hysterical 
spasms. 

Terebinthinoz Oleum, in enema, will often arrest a severe paroxysm when 
ordinary means fail. 



7& DISEASES OF THE OVARIES. 

* Valeriana is a valuable remedy ; it may be given both during the parox- 

ysm and in the intervals. 

Zinci Oxidum is considered by Dr. Waring-Curran as more efficacious 
in hysteria than the valerianate. 

Zinci Sulphas, in the dose of one grain, combined with extract of 
gentian, in pill, two or three times a day, is a valuable remedy 
in cases of hysteria depending upon debility. It will be found 
to agree better with many women than the preparations of iron, 
causing less irritation. 

Cathartics are to be administered if constipation exists, as it is important 
in hysteria to keep the bowels open. Aloes are indicated if 
there be torpor of the uterine system ; mercurials or podophyl- 
lin, if there be biliary derangement; and salines, if there be 
plethora ; but active purgation is in no case advisable. 

EXTERNAL REMEDIES. 

* Shower Baths are indispensable in the treatment of the paroxysms. 

(See p. 72.) 

Dry Cupping at the nape of the neck, between the shoulders, or below 
the clavicles, during a paroxysm of hysteria, has been found, by 
Dr. Graves, to be attended with the best results. 

Electricity. Dr. Laycock advises the persevering and systematic applica- 
tion of electro-galvanism to the abdominal and pelvic regions, 
in combination with the internal use of tar. 

Emetics. An emetic of ipecacuanha, given when the paroxysm is im- 
pending, often prevents it. 

Erigus. The sudden application of cold to the surface of the body, in 
hysterical cases simulating death, will revive the signs of life. 

Manipulation. Professor Thierry, of the St. Pierre Hospital, Brussels, 
arrests hysterical paroxysms by what he calls * ' torsion of the 
abdominal walls. He grasps in his hands the entire walls of 
the abdomen, either in their bare state or covered with the 
chemise, and imparts to them a certain amount of torsion, 
which he gradually increases, and which he maintains until the 
paroxysm has passed away, and the woman is come entirely to 
herself. 



CHLOROSIS. 

This name, or that of green sickness , is given to the anemic con- 
dition of young girls, associated with disordered menstrual func- 
tion. The blood has an excess of fibrine, and undergoes some 
chemical change in its pigments which produces the greenish hue 
of the skin, whence the disease has its name. Attention to hy- 
gienic conditions, baths, nutritious food, regularity of the bowels, 
and judicious mental and physical exercise, are first in import- 
ance. 

DR. FREDERICK T. ROBERTS. 

This writer on Practice considers aloes the best form of aperient, 
either the extract, or as ///. aloes cum myrrha. For the unpleas- 
ant sensations in the stomach, bismuth, with hydrocyanic acid, is 
particularly valuable. For the pain in the side often complained 
of, a belladonna plaster is usually efficacious. Iron is the great 
remedy; and it is frequently desirable to change the form of the 
preparation from time to time. 

PROF. A. P. REID, OF MONTREAL. 

This writer (Canada Medical Record, 1875,) has adopted, with 
signal success, in uncomplicated chlorosis, the use of liquor potassa, 
gtt.x-xv, in mucilage, thrice daily. It defibrinizes the blood, and 
often acts promptly for good where iron is of no avail. 

DR. BRETONNEAU, FRANCE. 

98. $. Ferri redacti, 3ij 

Quinias sulphatis, 

Zingiberis pulveris, aa gr.vij 

Extracti cinchonae, 9j 

Aloes socotrinae, gr.iij. M. 

Divide into fifty pills. One to five a day. These pills have the 
advantage of not causing constipation. 

DR. GAILLARD, PARIS. 

99. 1$. Ferri carbonatis, 

Extracti cinchonae, aa 3ijss 

Extracti opii, gr.xv. • M. 

Divide into one hundred pills. From two to four a day, principally at 
meal times. 

When there is constipation, this formula ought to be modified 
as follows : 

(77) 



y8 DISEASES OF THE OVARIES. 

ioo. I£. Ferri carbonatis, 5ij 

Extracti cinchonse, 

Extracti rhei, aa 5iss 

Extracti opii, gr.xv. M 

Divide into one hundred pills. To be taken as above. 

PROF. E. J. TILT, M. D., 

Believes that, in addition to the general treatment, we require some 
means of increasing ovarian energy. He directs the patient to 
wear during the day a bit of piline large enough to cover the 
ovarian regions, sprinkled with alcohol. 

DR. LOMBE ATTHILL, OF DUBLIN, 

Regards strychnia as of the highest value; he gives five drops of 
the liquor strychniae, equal to ^ of a grain of the alkaloid, gradu- 
ally increased to 10 drops three times a day, or combined with 
tincture of perchloride of iron. Strychnia acts as a powerful stim- 
ulus to the ovaries as well as a general tonic. When there is no 
anemia, five drops of tincture of iodine, and five of solution of 
strychnia, are of great value. 

For the constipation, he uses two grains of sulphate of iron with 
a quarter or half a grain of extract of aloes, three times a day. 
This often acts like a charm. 

PROF. T. GAILLARD THOMAS, M. D., NEW YORK. 

Regards the indications as to remove the cause, cure the neurosis, 
repair damages ; then change of air, well-regulated open air exer- 
cise, sea bathing ; tonics, as arsenic, strychnine and quinine. The 
continuous electric current and general electrization often are 
beneficial. 

For the anemia he gives : 



£>* 



ioi. fy. Ferri vini amari, f.^vijss 

Tr. nucis vomicae, f.5iv 

Liq. potas. arsenit., f.5ij. M. 

A dessertspoonful in a glassful of water just after each meal. 

GRAILLY HEWITT, M. D., LONDON, 

Regards the accompanying dyspepsia as best treated by food fre- 
quently and in very small quantities for days together, and of the 
simplest character, avoiding solids. Ferruginous preparations are 
essential, but should be given in small doses, and are best in the 
form of mineral waters. 



CHLOROSIS. 79 

HENRY Iff. FIELD, M. D., OF BOSTON. 

In cases of females where their maladies were connected with 
anemia indicating the use of iron, this writer has been very much 
pleased with the action of oxalate of iron, a preparation first brought 
to notice by Prof. Craig, of the Smithsonian Institute. It is a light 
and tasteless powder, with nothing repulsive in its appearance or 
odor. It may be given as a powder to those patients who object 
to the pill form. The dose is gr. ij-iij. He states that it is less 
liable to cause irritation or constipation of [the bowels than other 
ferruginous preparations, and many patients who have asserted 
they could not take iron in any form, have taken this without 
difficulty. 

RESUME OF REMEDIES. 

Aloes. This is frequently very efficient. (See p. 77.) 

Bismuthi Subnitras. Sir H. Marsh states {Medical Press, March 6th, 
1867), that in chlorosis, bismuth is an excellent substitute for 
iron, when the latter is not well borne. 

Coccuhis Indicus is recommended by Phillips in chlorosis with amenor- 
reha. 

Ergot, in five-grain doses, three or four times a day, is recommended by 
Churchill, in chlorosis and leucorrhea. 

* Ferri Iodidum. In chlorosis, accompanied by much torpor of the sys- 
tem, Dr. Ashwell has found this salt particularly efficacious, in 
the following formula : 

102. fy. Ferri iodidi, gr.xvj 

Tincturae calumbae, f.§j 

Aquas, f.§vij. M. 

Take two tablespoonfuls twice a day. 

*Ferri Mistura Composita, Ferri Chloridi Tinctura, Ferri et Quinice. 
Citras, Ferri Sulphas, and Ferri Vinum, are all excellent fer- 
ruginous preparations in chlorosis. 

Sir H. Marsh advises {Medical Press, March 6th, 1867), the 
following formulae : 



M. 



M. 

For two pills, to be taken at dinner-time, and repeated at night 
if necessary. 



103. I£. Liquoris ammonias citratis, 
Ferri et quinias citratis, 
Syrupi, 
Aquas, 

Two tablespoonfuls three times a day. 


f.?iij. 
gr.vij-xxiv 

f-?j 
f.?iv. 


104. ^. Ferri sulphatis, 

Aloes, aa 


gr-ij 


Pulveris cinnamomi, 


gr.v. 



80 DISEASES OF THE OVARIES. 

Sadce Biboras. Dr. Copland advises the following formula : 

105. ^. Sodae biboratis, 9ij 

Sulphuris praecipitatae, 5j 

Mucilaginis acacia;, q. s. M. 

Make twenty-four pills. Three to be taken three times daily. 

Nux Vomica. Dr. Copland has derived benefit in some obstinate cases 

of chlorosis from the following formula : 
1 

106. I£. Pilulae aloes c. myrrha, 5ij 

Extracti nucis vomicae, gr.x. M. 

Thirty-six pills. Take one to two night and morning. 

Potassce Liquor will occasionally overcome persistent anemia which has 
defied all other means. Dose 5ss-j, largely diluted, two or 
three times a day. 

[For the general treatment' of Anaemia see further suggestions in Nap keys' 
Medical Therapeutics, Chapter VI.] 



THE CLIMACTERIC EPOCH, OR THE CHANGE OF LIFE. 

PROF. ROBERT BARNES, M. D., LONDON. 

This author remarks that in many cases the local and constitu- 
tional disorders which attend the menopause are numerous and 
severe. Among these may be enumerated uterine and vicarious 
hemorrhages, a peculiar occipital headache, convulsive seizures, as 
vertigo and epilepsy, despondency, irritability, and loss of mental 
power, and various nervous disorders. Dyspepsia, colic, and 
excessive constipation, are among the most common attendants. 
Hysteria and pseudocyesis are also frequent. 

The principles of treatment are primarily to regulate the secre- 
tions, and exact a strictly hygienic mode of life. If the abdomen 
is large and the bowels distended with gas, a broad, well-fitting 
abdominal belt will give great relief. When the patient is plethoric 
and florid, the abstraction of eight or ten ounces of blood from 
the arm, or by half a dozen leeches behind the ears,' or by cupping 
between the shoulders, will often be of signal service. As an 
alterative, the acetate of ammonia is one of the best ; it may be 
combined with colchicum or lithia if a gouty diathesis is suspected. 
A most valuable remedy is bromide of potassium, gr. x-xx, two or 
three times a day, to calm and regulate the nervous centers. 
Quinine and strychnia are to be preferred as nerve tonics. To 
keep the bowels open the habitual use of laxative saline mineral 
waters is the most serviceable means. 

DR. G. E. SUSSDORF, OF GERMANY, 

In speaking of the general rules for the treatment of disease at 
the change of life, this author makes the following points (London 
Med. Record, Dec. 1878). 

1. The time of the menopause, as regards the inception and ag- 
gravation of disease, equals in importance that of puberty, or any 
other epoch of life. 

2. That while, as a rule, the majority of functional and organic 
diseases of the female generative organs decrease in intensity after 
the menopause, there is a considerable proportion of cases in 
which the reverse happens, even to the extent of the disease 
becoming malignant. 

6 (81) 



82 DISEASES OF THE OVARIES. 

3. In many instances these latter cases do not present decided 
local symptoms of the pathological conditions present, but are 
indicated by general signs, which attract attention because they 
occur at that particular time of life. 

4. In no case of general or local disorder, just before or during 
the menopause, should local examination be omitted, which will 
frequently reveal at a glance the origin of the hitherto inexplicable 
phenomena, and also indicate the therapeusis. 

5. Such therapeusis should be radical and effective, quite 
regardless of this particular time of life, the dangers of operating 
during which have been undoubtedly exaggerated. 

PROF. J. B. FONNSAGRIVES, OF MONTPELLIER. 

The indications of treatment for the complications of the meno- 
pause are as follows (Traite de Therapeutique Appliquee. Paris, 
1878): 

1. To combat the condition of general and local plethora. No 
measure is so frequently successful as general bleeding, espe- 
cially from the foot; or if the uterus is much congested, from the 
arm. The life should be active, the diet restricted, the sleep 
light, etc. 

2. To combat the menorrhagia. The two most efficacious drugs 
are ergot and the nrtica ure7ts, as : 

107. fy. Ergotinae, 

Extracti matico, aa gr.xv. M. 

Make ten pills. Give one every one or two hours. 

The urtica nrens may be given in decoction, 5j to aquae Oj, of 
which a wineglassful may be taken every hour or two. Cold baths 
taken twice a day during the intermenstrual period are often of 
service. Cold vaginal injections also are beneficial. 

3. To combat the nervous complications. These must be treated 
in detail as they present themselves. An enlightened hygiene is 
all important. As a rule the use of alcoholics, spiced food, and 
venereal excitements, should be prohibited. Dr. F. adds the ad- 
vice, that after the permanent cessation of the menses, sexual ap- 
proaches should absolutely cease, as they induce to the uterus a 
congestive afflux, which, useless for the function of reproduction, 
can only serve to cause various organic affections. 



THE CLIMACTERIC EPOCH, OR THE CHANGE OF LIFE. 83 

PROF. FORDYCE BARKER, M. D., OF NEW YORK. 

In monorrhagia associated with the climacteric period, the 
uterus is generally found somewhat increased in size and weight. 
When such is the case, Dr. Barker directs the patient to use for a 
week previous to the return of the expected period, rectal supposi- 
tories made after the following formula : 

108. 3, Extracti ergotae aquosae (Squibb), 9jj 

Butyri cocoae, 3j- M* 

Make twelve suppositories. Introduce one into the rectum morning, 
noon and night. 

They should be carried well up into the bowel, and the patient 
should lie down for an hour afterwards. 

Another plan of treatment, which is usually entirely successful 
if repeated for two menstrual returns, is to introduce into the cav- 
ity of the uterus cylinders of iodoform, made according to the fol- 
lowing formula : 

109. I£. Iodoformi, 3ijss 

Gum tragacanthae, gr.xv 

Mucilaginis, q. s. 

Divide into ten cylinders, each one and one-half inches in length. 

One of these is to be carried completely into the cavity of the 
uterus, and a pledget of cotton introduced against the cervix to 
retain it in position. One of these is to be introduced daily for 
five or six days before menstruation. The iodoform has an un- 
pleasant odor, but is the most efficient of all preparations which 
Dr. Barker has tried in these generally obstinate and troublesome 
cases. 

RESUME OF REMEDIES. 

Ammonia Acetas is considered by Dr. Barnes the best of the saline alter- 
atives. 

Car bo ileum Acidum. Dr. Bartlett, of New York {Buffalo Medical 
Journal, Sept., 1878,) places great confidence in carbolized 
sponge tents introduced within the cavity of the uterus. He 
has never seen ill effects, and has frequently controlled, by a 
single tent, climacteric hemorrhages which had resisted the or- 
dinary tampon and various astringents. He introduces the tent 
through the speculum, well up to the fundus, and tampons over 
it in the usual way. 

Ergot a is an invaluable drug in many cases. (F. 107.) 

Iodoform is very highly praised by Dr. Barker. (F. 109.) 



84 DISEASES OF THE OVARIES. 

Matico is given internally by Prof. Fonnsagrives. (F. 107.) 
Urtica. The various species of nettle have long enjoyed a reputation as 
efficient hemostatics in the hemorrhage of the critical epoch. 
Dr. W. B. Johnson, of Alabama, speaks highly of the urtica 
urens (New Orleans Medical and Surgical Journal, Vol. VI.), 
and Prof. Fonnsagrives gives the weight of authority in its 
favor. (P. 82.) 

Purgatives. Mr. Lawson Tait {Diseases of Women, 1879,) 
says that for the relief of nearly all the subjective symptoms of 
the climacteric period, he knows nothing better than the occa- 
sional use of a drastic purgative, and removal from home at 
frequent intervals. They take the place of bleeding, which, in 
small amounts, gives in some cases immense relief. 



CHAPTER II. 
DISEASES OF THE UTERUS AND ITS ANNEXES. 

Synopsis of Diagnostic Points — Metritis [Non-puerperal Endo-, Peri-, 
and Parametritis, Uterine Catarrh, etc) — Cervicitis {Ulcerations 
a?id Granulations of the Os, etc.} — Displacements — Non-malig- 
nant Groivths {Polypi, Fibroids, etc) — Malignant Growths — Steril- 
ity and Anaphrodisia — Nymphomania. 

SYNOPSIS OF DIAGNOSTIC POINTS. 

GENERAL OBSERVATIONS. 

The most enlightened school of modern gynecologists discoun 
tenance making gynecology a specialty, either 'in diagnosis or 
treatment. In other words, they insist on studying it as a depart- 
ment of general medicine. " There is, in truth," says Dr. Robert 
Barnes in a recent lecture {Lancet, May 25, 1878), "nothing more 
special in gynecology than there is in the study of heart disease, 
lung disease, or any other disease." And in the same spirit Prof. 
J. H. Etheridge, of Chicago, writes {Chicago Medical Journal and 
Examiner, November, 1878): "Just so far as gynecologists can 
separate this so-called ' science' from the general science of medi- 
cine, will they obscure the mind of the ordinary practitioner with 
the error that gynecological cases need special care and skill, and 
are beyond the necessity for general prescribing." 

As general rules in the diagnosis of uterine disease, Dr. Barnes 
recommends that all the functions and organs be studied in a cer- 
tain regular order, as follows : 

(1) Aspect, plumpness, color and state of the skin generally. 

(2) The circulation, pulse, respiration, and temperature. 

(3) Nutrition, the tongue, appetite, digestion, stomach, intestines, 
defecation, and bile. 

(4) The urinary organs, the kidneys and bladder, as to pain, as 
to retention or other characters, as well as the characters of the 
urine itself. 

(85) 



86 DISEASES OF THE UTERUS AND ITS ANNEXES. 

(5) The nervous system, sleep, motor power, general languor or 
exaltation, excito-motory system, mental state, delirium, pain, and 
its seat and kind. 

(6) The sexual organs, the menstrual functions, child-bearing, 
and the secretions. 

All these phenomena should be, as far as possible, explored by 
the aid of manipulation, and the appropriate instruments of ex- 
ploration. It is a dangerous thing to form a subjective diagnosis ; 
it is equally dangerous to accept the diagnosis from the patient. 

With regard to the special symptoms and signs which an exam- 
ination of the uterus and uterine functions may disclose, we quote 
from a lecture by Dr. Graily Hewitt the following two lists 
the first (A) a list of the symptoms of all kinds which may be 
observed in connection with diseases or affections of the uterus, 
these symptoms being placed as nearly as possible in their order 
of frequency. The second (B) is a list of the various physical 
changes which the uterus may undergo : 

A. Uterine Symptoms. 

f 1. Spontaneous. 
Pain^ 2. Produced by motion (dyskinesia). 

( 3. Undue sensitiveness of uterus to touch. 
Leucorrhea. 
Dysmenorrhea. 
Menorrhagia. 
Amenorrhea. 

[If married — Sterility, abortions.] 
Various reflex phenomena : — 

1. Sickness or nausea. 

2. Hysteria. 

3. Convulsions. 

4. Cephalalgia. 

5. Melancholia. 

Disturbance of functions of bladder. 
Disturbance of functions of rectum. 
Disturbance of sexual functions (dyspareunia). 

B. Uterine Changes (non-organic). 

Change in position. 
Change in size of walls. 

" " cavity. 

" " cervix. 

Change in shape. 
Change in patency of canals. 
Change in texture. ^ 

Undue hardness. 
Undue softness. 
Increased vascularity. 
Disorders of innervation. 
Increased secretion. 



SYNOPSIS OF DIAGNOSTIC POINTS. $7 

Here, then, we have the data for the construction of a pathology 
of the uterus; all the possible changes on one side, all the possible 
effects on the other. It must be understood that organic diseases 
of the uterus, cancer and fibroid tumor, are excluded from the 
list, the nature, course, and effects of these organic diseases being 
better understood. It must not, however, be forgotten that these 
organic diseases may occasion one or all of the uterine symp- 
toms. 

UTERINE INFLAMMATIONS 
Are usually divided into the acute and chronic forms of metritis, 
endometritis, cervicitis, and endocervicitis. The distinction has 
also been made between parametritis and perimetritis, and various 
forms of inflammation of the os, granular, catarrhal, ulcerative, 
etc. 

So far as treatment is concerned, in nearly all cases it is suffi- 
cient to distinguish between cervicitis, in which the os is alone or 
principally affected, and metritis, in which the body of the womb 
is also implicated. 

The distinctions which have been drawn between endometritis 
and endocervicitis, are compared by Dr. Etheridge on the follow- 
ing page : ' 



88 



DISEASES OF THE UTERUS AND ITS ANNEXES. 



Gene- 
ral 

symp- 
toms. 



2. Touch 



3. Specu- 
lum. 



4. Probe, 



:. Metritis. 



Acute. ( Very rare.) 



a. Violent pelvic 
pain, accompanied 
with rectal, vesical, 
and uterine tenesmus, 
and sometimes with 
nausea and vomiting. 

b. Pressure over ab- 
domen reveals great 
sensitiveness. 



a. Vagina hot and 
dry, unless, from co- 
existing endometritis, 
there be purulent dis- 
charge. 

b. Organ low in pel- 
vis, os enlarged, cer- 
vix swollen, pressure 
on cervix very painful. 

c. Painful tender- 
ness most apparent 
upon rectal touch and 
conjoined manipula- 
tion. 

a. Usually produces 
too much pain to be 
used. 



Chronic. 



a. Dull, heavy, 
dragging pain in pel- 
vis, increased by loco- 
motion. 

b. Defecation and 
coition painful. 

c. Menses accompa 
nied with pain, which 
begins several day 
previous. 

d. Pain in mammae 
during and before 
menstruation. 

e. Darkening of are 
olae of the breast. 

f. Nausea and vom 
iting. 

g. Great nervous dis- 
turbance. 

h. Pressure on rec 
turn, with hemorrhoids 
and tenesmus. 

i. Pressure on blad 
der, with vesical tenes 
mus. 

a. Enlargement. 

b. Tenderness. 



2. Cervicitis. 



Chronic. 



Nothing revealed 
specially. 



a. Pain in back and 
loins. 

b. Pressure on blad- 
der and rectum. 

c. Painful and some- 
times profuse men- 
struation. 

d. Difficulty of lo- 
comotion. 

e. Nervous disor- 
ders. 

f. Pain during sex- 
ual intercourse. 

g. Dyspepsia, head- 
ache, general lassi- 
tude, and debility. 



a. Uterus low down. 

b. Cervix large, 
swollen, and painful, 
and os may admit 
finger. 

c. Usually tender- 



Confirms signs 
evinced by touch. 



a. Produces intoler- 
able pain, and cannot 
usually be resorted to 



a. Usually reveals 
some flexion or ver 
sion, tenderness. 



Reveals great sen' 
sitiveness before 
reaching os internum, 
but nothing beyond 
that. 



SYNOPSIS OF DIAGNOSTIC POINTS. 



8 9 



3. Endometritis. 



General 
symp- 
toms. 



Chronic. 



a. Leucorrhea ; 
streaked, glairy,and 
bloody. 

b. Menstrual dis- 
orders. 

c. Pain in back, 
groins, and hypo- 
gastrium. 

d. Nervous disor- 
ders. 

e. Tympanitis. 

f. Symptoms of 
pregnancy. 

g. Sterility. 



4. Endocervicitis. 



Acute. 



Touch.! a. Conjoined ma 
.nipulation reveals 
tenderness of fun- 



a. Dragging 
weight and pain in 
pelvis, pain in back, 
groin and thighs. 

b. Rectal and ves- 
ical tenesmus. 

c. Purulent dis- 
charge, sometimes 
bloody after 3 or 4 
days. 

d. Tympanitis and 
tender abdomen. 



Specu- 
lum. 



Probe, 



dus. 



a. Reveals noth- 
ng special. 



Chronic. 

a. Dragging sensation in 
the pelvis. 

b. Pain in back and loins 
increased by exercise. 

c. Profuse, irritating leu- 
corrhea, like boiled starch. 

d. Menses, too scanty or 
vice versa, too frequent or 
vice versa. 

e. Nervous, irascible, 
moody, or even hysterical. 

f. Digestion impaired, 
ultimately spanemia, 
sometimes nausea, etc. 



a. Vagina hot and a. Os in normal position, 
dry, or covered with may be enlarged, lips puffy 
above discharge. or may be roughened. 

b. Os gaping, cer-! b. Pain results from plac- 
vix swollen and tending the finger under the 
der, body slightly .cervix and pressing up- 
enlarged, whole or-, wards, 
gan lower in pelvis 
than normal. 



a. Cervix puffy, 
swollen, and red, 
fluid exuding from 
os, either clear, al- 
buminous looking, 
muco-pus, or stringy 
and tenacious. 



a. Patulous os in- a. Great tender- 
ternum. ness throughout 

b. Uterine cavity. whole organ, and 
prolonged. removal followed 

c. Tend erne ss.'by a few drops of 
Withdrawal follow- blood. 

ed by blood. 



a. Long,stringy, tough, te- 
nacious mucus, difficult to 
remove, exuding from os. 
b. Cervix not usually en- 
larged, may be puffy and 
swollen and very red, as if 
ulcerated, due to removal 
of investing epithelium. 

a. Meets with obstruction 
at os internum. 

b. Does not produce pain 
by striking against the 
walls of the fundus, nor 
is its removal followed by 
blood or mucus. 



METRITIS (NON-PUERPERAL, ENDO-, PERI-, AND PARA- 
METRITIS, UTERINE CATARRH, ETC.) 

PROF. WM. H. BYFORD, M. D., OF CHICAGO. 

The treatment of chronic inflammations of the uterus, is divided 
into the general and local treatment. 

General Treatment. The patient must be placed under the best 
practicable hygienic and dietetic rules, and sexual congress for- 
bidden during treatment. For the nervous prostration, fresh and 
cold air is one of the most valuable tonics. The patient should be 
in the open air as much as possible ; or if confined to the house, 
she should be well covered and all the windows and doors of the 
room thrown open several times daily. She should keep in open 
cold rooms ; and the use of stimulants, to which such cases are 
given, should be forbidden. For the nervous excitability, regular 
rest, exercise, and outdoor exposure, are the most efficacious 
means. Medicines as a rule are not well borne in these cases. 
Quinine, nux vomica, wild cherry and chamomile, are the best. 
Stimulants must be exhibited cautiously, and opium is generally 
not well borne. Nervous headache, insomnia, and neuralgic pains, 
are often greatly relieved by bromide of potassium in full doses 
(gr. xxx-lx every hour in abundance of water, until relieved). 
Anemia and plethora, if present, must be appropriately met. Con- 
stipation is often present, and must be overcome by prompt atten- 
tention to the desire of defecation, by a full vegetable diet, espe- 
cially fruits, and by drugs. Of the latter, sulphate of magnesia, 
5ij-iv, may be given with some acid in the morning ; or gr. vj-x 
of blue mass may be given every fourth or fifth night, followed by 
Epsom salts in the morning. When through long habit, the secre- 
tions of the intestines are scanty, and their coats atonic, a special 
tonic is called for. Simple and effective formulae are : 

no. $. Strychnine sulphatis, gr.j 

Ferri sulphatis, gr. viij 

Acidi sulphuric! diluti, q. s. 

Aquae, f.gij. M. 

For a solution. One teaspoonful three times a day after eating. 

(9°) 



METRITIS. 91 

111. I£. Strychniae sulphatis, gr.j 

Extracti rhei, 9iss 

Sulphatis ferri, gr. x. M. 

For 16 pills. One to be taken once, twice or three times a day, as 
may be necessary. 

112. I£. Ouinias sulphatis, gr.j 

Pulveris nucis vomicae, gr.v. M. 

For one' pill. To be taken after each meal. 

These are our most valuable remedial agents. Massage is not 
unfrequently a valuable aid (See Resume of Remedies for the 
method employed). Cold water may be thrown into the rectum 
twice a day in small quantities, say f.gviij. Or a suppository may 
be used, as s 

1.13. fy. Extracti gentianae, 9j 

Butyri cocoae, q. s. M. 

For a rectal suppository. 

Quinine, gr. v, may be employed in a similar manner. 

As a means of relaxing the sphincter ani, and removing its irri- 
tability, we can sometimes employ with advantage an ointment of 
belladonna : 

114. I£. Extracti belladonnae, 3ij 

Unguenti simplicis, §j. M. 

Ayply to the anus externally on going to bed at night. 

When the rectum is weak and becomes readily filled with accu- 
mulated feces, this can in a measure be prevented by wearing an 
air or sponge pessary, which will press the rectum against the 
sacrum and thus reduce its capacity. 

Local Treatment. Of the local measures employed, baths may 
be first mentioned. Injections are internal baths. The most com- 
mon bath is the sitz- or hip-bath. Where there is much pain, with 
little inflammatory action, this often affords great relief. In many 
cases the patient can advantageously introduce a speculum while in 
the bath, so that the medicated water can readily reach the uterus. 
That temperature should be chosen which is most comfortable to 
the patient. Vaginal injections are applicable to almost all cases 
of cervical inflammation. Dr. Byford condemns intra-uterine in- 
jections as dangerous. The quantity of simple injections should 
generally be large — from one to eight quarts. Astringent injec- 
tions ought not to be used more often than twice a day, the rule 



92 DISEASES OF THE UTERUS AND ITS ANNEXES. 

being never to repeat so long as the vagina is dry from the preced- 
ing one. The temperature should be governed by the feelings of 
the patient. 

Anodyne, astringent and alterative suppositories, pessaries, and 
powders, may be resorted to with profit in many instances. The 
"suppository syringe" will enable the patient to place ointment in 
contact with the uterus very conveniently. In using narcotics in 
the vagina, the proper dose is double that by the mouth. The 
vaginal mucous membrane absorbs much more slowly than that of 
the rectum. 

The local remedies most employed by Dr. B. are the various 
depletory measures, nitrate of silver, tannin, acid nitrate of mer- 
cury, nitric acid, and caustic potassa. 

Nitrate of silver he prefers in the solid form. It should be 
slowly and gently passed over the inflamed or ulcerated part. 
If we use no more force than is necessary to keep it in contact 
with the part, there is no danger of keeping it there too long. It 
can be applied about once in six days. If applied in solution it 
should be strong — one part to four of water. It is not so applica- 
ble in aged persons, and they are often made worse by it. Creo- 
sote or caustic potassa is better in these cases. It also sometimes 
causes such severe pain that a substitute must be found. 

DR. LOMBE ATTHILL, OF DUBLIN. 

Chronic Endometritis. This disease presents itself in two forms, 
requiring different treatment. I. As it appears in women who 
have borne children ; and 2, in nulliparae and virgins. 

In women who have borne children the os is patulous and the 
sound is readily introduced, although causing pain. The lips of 
the os are usually swollen and soft. An important preliminary 
step in such cases is local depletion by puncturing the cervix. One 
or two punctures, one-eighth of an inch in depth, will generally be 
followed by sufficiently free bleeding. To this should follow the 
application of strong caustics to the interior of the uterus. Dr. 
A. prefers nitric acid and the solid nitrate of silver. Nitric acid 
seldom causes any pain if properly applied, and it has a wonderful 
effect in bringing about a healthy condition of the mucous mem- 
brane. It is readily applied on cotton, through the author's 
platinum canula or similar instrument. Carbolic acid may also 



METRITIS. 93 

prove serviceable in mild cases. If vegetations on the endome- 
trium exist, they should be removed with the curette before the 
caustic is applied. 

In virgins and women who have never been pregnant, endome- 
tritis is usually accompanied by an elongated, probably swollen 
and congested cervix uteri, with a very small os from which a clear 
and slightly viscid discharge exudes. Flexion of the fundus is 
also often present. In these cases the first indication is division of 
the ccj-vix so as to insure a free escape for the contents of the 
uterus. Often this procedure will be sufficient : if it is not, we 
should have recourse to the subsequent treatment of the unhealthy 
mucous membrane by the application of carbolic acid, or some 
similar agent. 

Dr. A. regards blisters as of great value in chronic metritis and 
endometritis, where local blood-letting does not relieve. He 
applies them of small size, about two inches in diameter, and 
repeats them at intervals of a few days, placing them alternately 
over the sacrum and over the pubes, or over the ovary, if that be 
the chief seat of pain. 

In debilitated patients the application of iodine is preferable to 
blisters, as it does not weaken so much. Its use must be contin- 
ued for weeks, and it is best to direct it to be rubbed in over a 
limited space only, and when that spot becomes tender, to apply 
it to an adjoining part. 

To relieve the distressing backache in these affections, Dr. A. 
recommends : 

115. $. Linimenti camphorae comp., f.5x 

Tincturae aconiti, 

Chloroformi, aa f.5iij. M. 

For a liniment. 

Or, 

116. ^. Unguenti veratriae, 

Unguenti potassii iodidi, Partes aequales.M. 

For an ointment. 

Either of these is to be well rubbed in over the seat of pain. 

DR. L. PLAYFAIR, LONDON. 

This writer observes that in many long-standing cases of ute- 
rine catarrh it is vain to expect a permanent cure by any means 



94 DISEASES OF THE UTERUS AND ITS ANNEXES. 

which do not act directly on the seat of the disease, which is the 
lining membrane of the cavity of the uterus and cervical canal be- 
yond the external os ; accompanied, of course, with secondary 
morbid states of the body of the uterus and cervix, such as hy- 
pertrophy, congestion, etc. Rest, applications to the exterior of 
the cervix, and general treatment, will unquestionably cause a 
temporary improvement, but on a recurrence to the old habits of 
life all the old symptoms return. There are serious objections to 
intra-uterine injections, unless the os is first dilated with laminaria 
tents, as they are apt to bring on severe uterine colics. By means 
of fine probes of whalebone or flexible metal round which a thin 
film of fine cotton wool is wrapped, alterative applications can 
readily be made to the interior of the uterus, without pain or dan- 
ger. In the very numerous cases in which this plan of treatment 
has been carried out, in no single instance has anything but the 
greatest benefit accrued. It is no doubt advisable to select the 
cases judiciously, and where there is much uterine tenderness, 
intra-uterine treatment should be postponed until this has been di- 
minished by rest, leeching, etc. ; but with proper precaution the 
treatment is perfectly safe. A concentrated solution of carbolic 
acid, eighty parts to twenty of water, is used, and it acts so well that 
for a long time nothing else has been employed. After the first 
application, the discharge is sometimes increased, but after the 
second or third it is generally greatly diminished, and a single 
application is often sufficient to cure superficia lerosions of the 
cervix. As a rule, there is no difficulty in passing the probes, as 
in true uterine catarrh the os is invariably patulous. 

PROF. ROBERT BARNES, M. D., LONDON, 

In cases of simple metritis, applies twelve to twenty leeches 
above the pubes. A plasma consisting of one drachm of extract 
of belladonna, mixed with half an ounce of mild blue ointment, 
and two ounces of simple cerate, spread thinly in lint and applied 
to the hypogastrium, the whole covered with cotton wool, will give 
ease and subdue the inflammation. Tepid vaginal irrigations with 
water or decoction of poppyheads, or with laudanum, are useful. 
One grain of calomel with half a grain of opium may be given 
every six hours for a day or two, taking care not to salivate. Next 
salines, especially the acetate of ammonia, and nitrate of potassa, 



METRITIS. 95 

with sedatives, are useful. When there is septic infection, avoid 
leeches. Use the plasma as above, and salines combined with qui- 
nine and tonics. Offensive discharges are to be corrected by in- 
trauterine injections of permanganate of potassa in carbolic acid. 

In the chronic form, it is important to aid the womb in throw- 
ing off its congestion, and hence support by a proper pessary is 
very useful. Warmth is of great service, as by heated bags of salt 
or bran, or water to the hypogastrium, or even the whole, or hip- 
bath, at 90 to 95 F. Free access must be given for the warm 
water to the vagina, by the use of the bath speculum. Irrigation 
may be employed, as the use of the patent syringe to play upon the 
cervix for fifteen or twenty minutes at a time. The general treat- 
ment must be tonic. 

PROF. T. GAILLARD THOMAS, NEW YORK, 

Insists upon perfect rest in bed. He applies warm poultices in 
towels wrung out of hot water to the hypogastrium, and covered 
with oil-silk. The patient should be kept under the moderate use 
of opium. 

In chronic cervical endometritis, he relies upon general regimen 
as the removal of depressing influences, etc.; vegetable tonics, 
mineral acids and iron ; appropriate diet, but no stimulation ; fresh 
air and exercise. As a tonic and cathartic he gives: 

117. ^. Magnesias sulphatis, §ij 

Ferri sulphatis, gr. xvj 

Ac. sulph. dil., f.3j 

Aquae, Oj. M. 

Two tablespoonfuls in a tumbler of iced water daily on rising. 

Or, 

118. ^. Sodii et potassae tart., Sjij 

Vini ferri amari, f.gij 

Ac. tartarici, f.5iij 

Aquae, f.^xiv. M. 

Two tablespoonfuls as above. 

If necessary, the draught may be repeated during the day. 
As a digestive tonic, he gives : 

119. I£. One rennet washed and chopped, 

Sherry wine, Oj 

Macerate for twelve days, decant, filter 

and add 
Ac. muriat. dilut, 

Tr. nucis vom., aa f.5ij 

Bismuthi subnit., 5ij. 

One teaspoonful in a quarter of a tumbler of water, before each meal 



g6 DISEASES OF THE UTERUS AND ITS ANNEXES. 

Emollient Applications. Irrigations for twenty or thirty minutes 
of the cervix night and morning by warm water, with the addition 
of salt, glycerine, boiled starch, infusion of linseed, slippery-elm, 
or tincture of opium. 

Alterative Applications. First, dilatation of the cervix. The sur- 
face having been thoroughly cleansed, it should be well painted 
with a saturated solution of copper, zinc or lead. Next a bit of 
cotton with a piece of stout thread attached, dipped in glycerine, 
should be applied to the cervix. This treatment may be repeated 
once a week. 

Or applications may be made by means of the probe wrapped 
with cotton, which is then saturated with the solution to be em- 
ployed. 

LAWSON TAIT, F. R. C. S., BRIMINGHAM. 

The treatment of chronic metritis consists most essentially in ab- 
solute rest in bed during menstruation, and total suspension of 
marital life. For medicines there is nothing like bromide of po- 
tassium and ergot, and there is nothing so bad as iron. No mat- 
ter how anemic the patient is, iron should not be given until the 
uterine condition is cured, after which, indeed, it will often work 
marvels. Intra-uterine remedies are powerful adjuvants. Desic- 
cated sulphate of zinc, carbolic acid, and even nitric acid, may be 
used. Where the chronic metritis is the result of an acute pro- 
cess, very great caution must be observed in applying any intra- 
uterine medication, lest the original mischief be re-excited. 

Acute Endometritis is nearly always the result of gonorrheal in- 
fection. Its characteristic signs are severe pain, some fever, ten- 
derness of the uterus, and a profuse yellow purulent discharge 
from the os. The treatment is rest in bed, pessaries of lead and 
opium, hot fomentations over the abdomen, or even a blister, with 
general antiphlogistic measures. Both vaginal and iritra-uterine 
injections are to be sedulously avoided. 

Parametritis often occurs in the first few months of wedded life. 
Its treatment is by absolute rest in bed, with opiates and warm fo- 
mentations or poultices. If the tumor can be felt from the vagina, 
it should be tapped as soon as the indications of pus are clear. 

PHILADELPHIA HOSPITAL. 

Perimetritis. As regards internal remedies, one-twenty-fourth 
of a grain of the bichloride of mercury, with ten grains of the 



METRITIS. 97 

muriate of ammonia, are given three times each day in the mist, 
glycyrrh. comp. A pessary of cotton is constructed, which can be 
so adjusted as to hold the womb up. This cotton is dipped in a 
solution containing three-quarters of a grain of morphia to the 
drachm of glycerine. The morphia allays the pain and reduces 
the inflammation, and the glycerine usually sets up a copious 
watery discharge from the vagina. Iron is not employed until late 
in the progress of the disease. 

After the inflammation is subdued, the patient is put upon the 
following mixture: 

1 20. 3. 



M. 



Hydrarg. chloridi corros., 


gr-j 


Liq. chloridi arsenitis, 


f.3ss 


Mist, ferri criioridi, 




Acid, muriat. dil., 


aa f.5ij 


Syrupi, 


f.iiij 


Aquam, 


q. s. ad f.fvj. 



S. One tablespoonful after each meal. 



DR. ROBERT BATTEY, OF ROME, GEORGIA. 

This writer has found of excellent effect what he denominates 
iodized phenol (American Practitioner, Feb., 1877). 

121. fy. Iodinii, §ss 

Acidi carbolici crystal., §j. M. 

Combine by gentle heat. 

This is an energetic escharotic and alterative, and may be used, 
applied on lint or cotton, to cancerous surfaces. But for metritis, 
chronic affections of the cervix, hypertrophy, and subinvolution, 
he takes the following : 



M. 



This is to be used either of full strength or diluted with glycer- 
ine, to one-half, one-third, or one-fourth, according to the nature 
and requirements of the case. It is applied on cotton, the interior 
of the canal and uterus being mopped out (after the dilatation of 
the inner os), with the fluid. 

DR. V. H. TALIAFERRO, OF ATLANTA, GEORGIA. 

Pressure in Uterine Diseases. This practitioner has brought prom- 
inently to notice the application of pressure in diseases of the 
7 



122. $. Phenol iod. (No. ), 


fiss 


Acidi carbolici crystal., 


S 


Aquae, 


f.3ij. 


Make a solution. 





98 DISEASES OF THE UTERUS AND ITS ANNEXES. 

uterus, especially in the forms of chronic metritis (Trans. Med. 
Assoc. Ga., 1878). The pressure is exerted by filling the vagina 
firmly with well-prepared cotton or sheep's wool, in the manner of 
a tampon. 

In commencing the use of this tampon, the vagina should not 
be entirely filled. It is better to fill first the upper portion of the 
canal, which may be done quite tightly, and gradually to encroach 
upon the entire canal as it becomes inured to the foreign sub- 
stance. Not unfrequently the tampon will irritate the vagina in 
the commencement of treating by its use, when it should be left 
off for a day or two, and hot water injections substituted. If, how- 
ever, there be but little irritation, the use of a little simple cerate, 
or better, vasaline, upon the vaginal surface, will enable us to con- 
tinue the tampon. 

He is convinced that in this method we have a remedy for the 
rapid reduction of chronic congestions of the part, superior to any 
other. In adhesions of the uterus, with inflammatory deposits, 
however extensive, its patient and persistent use is absolutely cur- 
ative. 

INTRA-UTERINE MEDICATION. 

This is applied in the various forms of injections, pledgets, oint- 
ments, pessaries, crayons or pencils, capsules, and powders. 

UTERINE INJECTIONS. 
Prof. Carl Schroeder, of Erlangen, recommends the following 
cautions in the use of uterine injections: 

1. They should be avoided where there is marked tenderness or 
inflammation of the uterus or its appendages. 

2. There must be a free exit of the injected fluid ; hence it is 
better first to dilate, in every case, the uterine neck. 

3. Only a small quantity of fluid must be injected. 

4. The fluid should be slightly warmed, and slowly injected. 

5. Where there is flexion of the uterus, it is advisable to draw 
the fluid back into the syringe after a minute or two. 

Of substances used, probably the solutions of alum and iodine 
are the most useful, and these do not form precipitates with the 
albumen of the discharge, as iron, acetate of lead, nitrate of silver, 
etc. 

The safety of uterine injections has been much debated of late 
years, and is doubted by Drs. T. G. Thomas, and Paul F. Munde, 



METRITIS. 99 

of New York, and others ; but the tendency now is to consider 
them as without risk, if not too violent, and performed with all 
necessary precautions, especially that the internal os or cervix be 
fully dilated. Nevertheless, it is true that the French writers (Gal- 
lard, Leblond, Guichard, etc.,) reject this dilatation as not ne- 
cessary. 

A sense of heat, some pain, and a slight febrile movement, 
often follow an intra-uterine injection, and continue some hours. 
Should these symptoms not disappear, an anodyne poultice should 
be laid over the abdomen, and a moderate dose of opium or mor- 
phine be given. 

Contra-indications. Any acute inflammation in or near the 
uterus is a positive contraindication against the use of intra-uterine 
injections. Hence where there is cystitis, ovaritis, or perimetritis 
in an acute form, we must not have recourse to this means. It is 
also advised on similar grounds to avoid this form of medication 
during the menstrual epoch, and for a week before and after the 
period. 

A marked uterine flexion is also held to be a contra-indication, 
inasmuch as the Fallopian tubes may be so displaced and dilated 
that the fluid may easily find its way into the peritoneum, giving 
rise to serious results. 

Medicated Injections. One of the most successful agents in intra- 
uterine medication is " Dr. Churchill's tincture of iodine." Ac- 
cording to the formula given by that author in 1864, it is made as 
follows : 

123. 1$.. Iodinii, ^iiss. 

Potassii iodidi, §ss 

Alcoholis, Oj. • M. 

This is used with great advantage as a stimulant, alterative, 
counter-irritant, caustic, and hemostatic. It has been very exten- 
sively employed in the New York State Women's Hospital. The 
internal os is thoroughly dilated, and the instrument used for in- 
jection is an ordinary hard rubber uterine syringe. The patient is 
strictly enjoined to keep her bed for a week after the injection. 
In chronic endometral disease, and after the removal of fibroids, 
etc., its action is exceedingly beneficial. 

Dr. E. J. Tilt considers iodine the safest agent to inject into the 
uterus. He recommends the employment of a one ounce india- 
rubber bottle with a pointed nozzle, fitting tightly into the end of 
a female catheter. The principal formulas he employs are : 



IOO DISEASES OF THE UTERUS AND ITS ANNEXES. 



24. 


$. 


Tincturas iodinii, 
Aquae destillatae, 


aa f.3;j. 


M. 


25. 


5. 


Liquoris ferri subsulphatis, 
Aquae destillatae, 


f.5v 

f.liv. 


M. 


26. 


$. 


Ferri perchloridi, 
Sodii bicarbonatis, 
Aquae destillatae, 


3ij 

gr.x 


M. 


27. 


$. 


Acidi chromici, 
Aquae destillatae, 


3ij 


M. 



As a vehicle, glycerine is preferred by some, as it flows more 
slowly, and thus exerts the action of the agent for a longer time 
upon the uterine walls. As it is somewhat harsh when applied 
pure, it should be diluted. Oil of sweet almonds may also be em- 
ployed. Dr. Liebman uses, 

128. fy. Tincturae ferri perchloridi, 1 part 

Glycerinae, 10 parts. M. 

Nitrate of silver should not be used for intra- uterine injections, 
as even in weak solutions it gives rise to violent uterine colics, 
often of long duration. 

The Swedes favor the sulphate of copper. Dr. Eckland of 
Sweden states that in the severer cases with ulcerations, hyper- 
trophy and neoplasms of the papillae, the best agent is sulphate of 
copper, with which, in dilute form (1:5 to 1:50). This author has 
had extensive experience, applying it by means of an applicator 
to the entire interior of the uterus, it being very efficacious, with- 
out being followed by any inconvenience, such as erosion of the 
mucous membrane, which is produced by some of the other agents 
employed. 

Prof. James P. White, M. D., of Buffalo, in catarrhal metritis, 
prefers the following as a local application : 

129. fy. Iodinii, 5i 

Potassii iodidi, 5ss 

Acidi tannici, 5j 

Glycerinae, q. s. to dissolve. 

Dr. W. W. Wilkens, of New Hampshire {Half Yearly Com- 
pend., i8j6), speaks very favorably of the following : 

130. I£. Acidi carbolici crystal., 

Aquae, q. s. to dissolve. 

Glycerinae, aa equal parts. M. 



METRITIS. 101 

This mixture will not cauterize or destroy tissue. It may be applied 
to a healthy mucous membrane without inflaming it ; but it will 
stimulate to healthy action one already inflamed. It should be ap- 
plied to the entire mucous membrane of the womb every week or 
ten days. As a rule, no pain follows its use, and it never causes 
metritis or has other dangerous sequelae. 

" Lugol's solution " of iodine in a concentrated form has been 
found efficacious by Dr. Joseph Kammerer. His formula is : 

131. $. Iodinii, 1 part 

Potassii iodidi, 2 parts 

Aquae, 4 parts. M. 

Its use is chiefly indicated where catarrh of the uterus is com- 
bined with hypertrophy of tissue. 

Where the surface is eroded with a tendency to hemorrhage, the 
same practitioner employs pyroligneous acid in its undiluted form, 
or else carbolic acid dissolved in an equal part of water. In those 
cases of hypersecretion where no erosions are visible, the follow- 
ing is a valuable astringent: 

132. I£. Zinci sulphatis, gr. x 

Aquae, f.Jj. M. 

PLEDGETS (PINCEAUX). 

These are small masses of cotton, charpie, sponge, or other soft 
and porous substance, which are moistened with the medicated 
fluid and applied to the inner wall of the uterus. They are in- 
serted by means of various instruments, as the " applicator" of Dr. 
H. E. Woodbury, of Washington, or that devised by Barnes. 

The liquids used in this manner are tincture of iodine, p ere hlonde 
of iron, solutions of nitrate of silver, and nitric acid. The last 
mentioned agent especially has given excellent results in the hands 
of a large number of practitioners, in the treatment of chronic 
endometritis. The slight pain which it produces and the rapidity 
of its effects make good its claim to be the most valuable of 
all applications in many cases of this malady. 

The use of such pledgets is preferable to other means in the 
lighter forms of endometritis, where there is little or no hemor- 
rhage, where the intra-uterine area is small, dilatation slight or 
absent, and the canal not tortuous. They should not be em- 
ployed when inflammation is active. 



102 DISEASES OF THE UTERUS AND ITS ANNEXES. 

CRAYONS OR PENCILS. 
These are inserted into the uterine cavity and allowed to remain, 
the cervical canal being stopped by a plug of cotton. For ex- 
ample : 

133. I£. Iodoformi, 5ijss 

Pulv. acacias, 

Mucilaginis, q. s. 

Divide into ten equal cylinders about one-and-a-half inches long. 

These pencils are hard, resisting, and capable of being divided 
into pieces of any length ; they should be preserved from light. 
They are used with advantage against superficial ulcerations of the 
uterus. They are introduced into the cavity and allowed to re- 
main. 

Nitrate of silver has been largely used in this manner. Re- 
camier introduced the solid nitrate into the body of the womb by 
means of Lallemand's porte caustique. Dr. Tilt prefers the porte 
caustique of Simpson, and leaves gr.v-x of the lunar stick to dis- 
solve, provided the os be fully dilated. 

Prof. Pajot, (Annates de Gynecologie, 1877, No. 21,) takes a 
laminaria tent two millimetres in diameter, dips it in thick mucilage, 
and then rolls it in finely powdered fused nitrate of silver, and al- 
lows it to dry. He thus obtains an elastic crayon of the ordi- 
nary size, which may be introduced into the uterus without fear of 
breaking. He believes this means to be applicable to other cavi- 
ties, and for other more powerful caustics. 

The sulphate of zinc is also prepared in the form of crayons, 
twelve to fifteen centigrammes of the salt in each, for introduction 
in this form into the uterus ; it is recommended by Leblond, and 
is considered by Barnes one of the most useful agents in uterine 
catarrh. (See page 107.) 

Crayons of tannin have been used by some, but on account of 
their tendency to produce severe uterine colic and other accidents, 
they are not to be recommended. 

OINTMENTS AND GLYCEROLES. 
Dr. Robert Barnes remarks (British Medical Journal, January, 
1873), that a most precious way of applying almost any medicinal 
agent to the interior of the uterus is in the form of an ointment or 
pasma. They can be introduced by means of a hollow sound, 
with a piston working in its centre, the " ointment positor." Where 



METRITIS. 103 

grease is objectionable, glycerine, cocoa butter, cosmoline, vaseline, 
etc., may be used. Thus bromine, iodine, mercury, etc., can be 
safely applied. 

In simple chronic endometritis, Dr. A. Leblond (Traitc de Chi- 
rurgie Gynccologiquc, 1878), has employed the following with ex- 
cellent effect: 

134. $. Cerati simplicis, 20 grammes 

Pulveris iodoformi, 

Olei amygdal. dulc, aa 5 grammes. 

In cold weather, the amount of oil should be increased. 

Glyceroles of starch, tannin, and other substances, may also be 
employed. s 

CAPSULES. 

The introduction into the uterine cavity of various medical sub- 
stances enclosed in capsules has been suggested by Dr. E. P. Sale, 
of Aberdeen, Miss. {American Practitioner, June, 1875). They may 
be made of gelatine, and introduced in the same manner as 
pledgets. 

POWDERS. 

The insufflation of powders of alum, tannin, calomel, iodoform, 
etc., into the uterine cavity has been practiced by Prof. N. Guen- 
eaude Mussy and others. Several serious accidents have, how- 
ever, resulted with most of these agents in this form, and except, 
perhaps, in the case of iodoform, there is no advantage, and an ab- 
sence of safety in this plan of medication. 

PESSARIES, OR INTRA-UTERINE TENTS. 

These are usually of cotton, saturated with some medicated 
fluid, allowed to dry, and introduced by a probe or a positor. The 
internal os generally requires to be dilated before this can be done. 
A thread may be attached to the tent, by which it may be with- 
drawn after a few hours ; or, it may be allowed to remain until 
thrown off by the action of the uterus, which usually occurs 
within forty-eight hours (Battey). 

RESUME OF REMEDIES. 

Acidum Carboliciim is used as a local application by Playfair (page 94). 
Acidum Chromicum is advocated as a cauterant by Dr. Tilt (F.126). Its 

application to the uterus sometimes produces the most severe 

vomiting, hence it is not very safe (Tait). 



104 DISEASES OF THE UTERUS AND ITS ANNEXES. 

Acidum Nitricum is one of the most efficient local caustics in many cases. 
For introduction into the uterus it is probably the safest of the 
fluid caustics. See pages 92, 101. The following method of 
using it is recommended by Dr. D. N. Kinsman, as possessing 
advantages over any other {Obstetric Gazette, Nov. 1878): A 
piece of white wax smoothed down to the requisite size to enter 
the cervical cavity and given the proper curve, is dipped into 
the acid ; a sufficient quantity adheres, for the purpose to which 
it is to be applied. The wax bougie is grasped with a pair of 
dressing forceps and passed into the cervix ; applied in this 
manner there is no excess of acid to run over adjacent parts, 
while there is enough to act as a caustic or alterant. 

Argenti Nitras is preferred as a caustic by many physicians. 

Belladonna, internally, is recommended (F. 114). 

Boracicum Acidum has been suggested as a useful agent. 

Cupri Sulphas is used in Europe (p. 100). 

Ferrum. The preparations of iron are used internally as tonics, and the 
tincture of the chloride locally (F. 128;. Tait warns against 
iron in any form in chronic metritis (See p. 96 . 

lodinium in several forms is in use by nearly all practitioners (F. 121, 123). 

Iodoformum, although disagreeable to most patients, has been found an 
excellent application (F. 133). 

Tannicum Acidum is an astringent of great value. 

Veratria, in the form of ointment, is an efficient local anodyne (F. 116). 

Zinci Sulphas was applied in undiluted form to morbid uterine tissues by 
Simpson. Others have preferred it more or less diluted and 
made into sticks. 

EXTERNAL MEASURES. 

Blisters are highly commended by Dr. Atthill. (p.,93-) 
Massage of the Uterus. This has been recommended in uterine atro- 
phy, chronic metritis, and chronic uterine catarrh, by Prof. G.~ 
Asp, of Helsingford (Schmidt's Jahrbiicher, Bd., 181,) and 
others. The proceeding, as stated by this writer, is as follows : 
The operator with one or two fingers in the vagina grasps the 
body of the uterus so that he can exert upon it a steady pres- 
sure, while the counter pressure is exerted by the other hand 
through the walls of the lower abdomen. If these walls are 
sufficiently loose and enlarged, by this procedure the uterus 
can be held between the fingers of the two hands, and gently 
pressed and kneaded. When the organ is displaced, it is usu- 
ally necessary to correct the displacement before this method 
can be effectually used. 






CERVICITIS (ULCERATION AND GRANULATION 
OF THE OS, ETC.) 

ROBERT ELLIS, M. D., OF LONDON. 

This author defines as follows the varieties of ulceration of the 
os, and what he considers the very best methods of treating them. 

I. Indolent Ulcer. Cervix hypertrophied, of a pale pink color, 
and hard. Os patulous to a small extent. Ulcer of a rose red. 
Granulations large, flat, insensitive, and the edge of the ulcer 
sharply defined. Discharge : mucus, with a little pus, and occa- 
sionally a drop of blood. 

Treatment. For. a few times the caustic pencil — solid nitrate 
silver. Afterward, the solution of nitrate of silver in strong nitric 
acid. 

2. Inflamed Ulcer. Cervix tender, hard, a little hypertrophied, 
hot and red. Vagina hot and tender. Ulcer of a vivid red. Gran- 
ulations small and bleeding. A livid red border around the ulcer. 
Discharge : a muco-pus, yellow and viscid, with frequently a drop 
of bright-red blood entangled in it. 

Tieatment. Occasional leeching, hip-bath (warm), emollient in- 
jections. Then acid nitrate of mercury several times, succeeded 
by the solid lunar caustic, potassa fusa, or cum calce. 

3. Fungous Ulcer. Cervix soft, large, spongy to the touch. Os 
wide open, so as to admit the finger. Ulcer large, pale, studded 
with large and friable granulations. Discharge : glairy, brownish 
mucus, frequently deeply tinged with blood. 

Treatment. At first, the caustic pencil. Subsequently, nitric 
acid, solution of nitrate of silver, or acid nitrate of mercury; elec- 
tric, or actual cautery. 

4. Senile Ulcer. Cervix small, red, a little hard. Ulcer small, 
extremely sensitive, of a bright-red color. Granulations very 
small, red, and irritable. Discharge : a thin muco-pus. 

Treatment. Potassa fusa, or strong nitric acid, with nitrate of 
silver once or twice at long intervals. The solid sulphate of cop- 
per, in pencil. 

5. Diphtheritic Ulcer. Cervix of ordinary size, a little hot, dry, and 
tender. Ulcer covered in patches with a white membrane, adher- 

(105) 



106 DISEASES OF THE UTERUS AND ITS ANNEXES. 

ing closely, irritable, and readily bleeding beneath. Discharge : a 
thin acrid mucus, without pus, but occasionally tinged with blood. 
Treatment, At first, electric cautery, potassa cum calce, or acid 
nitrate of mercury, two or three times at long intervals. No 
nitrate of silver. Subsequently, stimulating applications, tincture 
of iodine, or sulphate of copper. 

DR. A. LEBLOND, OF PARIS. 

This writer states that (Traite Elementaire de Chiruagie Gyneco- 
logique, Paris, 1878,) the treatment of the os and cervix by means 
of cauterizing agents is so prominent that it deserves to fix our 
attention. The caustics employed are directed (1) to the surface 
the os of and cervix, or (2) to the parenchyma. They have also 
been classified as (1) mild, and (2) energetic caustics. 

In follicular ulceration of the surface of the os and cervix, a 
strong solution of nitrate of silver gives excellent results. The ap- 
plication produces a slight eschar, which is detached in five or six 
days, after which it may or may not be renewed. 

When the ulcerated surface is red and softened with tumefaction 
of the cervix, the tincture of iodine is to be preferred on account of 
its resolvent properties ; or, what in some respects is better, iodo- 
form, which is at once an energetic cicatrizant and a local anaes- 
thetic. 

Bleeding ulcerations, with a varicose aspect, will be happily 
modified by a solution of perchloride of iron @ 30 . It should be 
repeated at the close of five or six days. 

Obstinate ulcerations will sometimes yield in a satisfactory man- 
ner by application of a solution of hydrate of chloral. 

135. ]£. Chloral hydratis, 2 grammes 

Aquas, 25 grammes. 

The ulceration to be touched daily with this for some time. 

When the ulcerations are swollen and fungous, a more potent 
caustic than those above mentioned is required. Scanzoni used 
pyroligneous acid ; Dr. Gallard, crystallized acetic acid, or carbolic 
acid. The first mentioned is the least painful. 

Pencils or crayons of nitrate of silver, sulphate of zinc, perchlo- 
ride of iron, iodoform, or other substances, may often be advanta- 
geously employed. Those of tannin are to be prepared as follows : 



CERVICITIS. IO7 

136. fy. Tannin, 1 gramme 

Pure glycerine, 1^ drops. 

Rub together and roll into two crayons each 5 centimetres in length. 

The most suitable formula for crayons of the other ingredients 
mentioned is the following : 

137. fy. Sulphate oT zinc (or other agent), 

Gelatine, aa 2}4 grammes 

Pure glycerine, 5 drops. 

To make ten crayons of 6 centimetres each. Powder the gelatine and 
place in a capsule in a sand-bath. Add the glycerine and ten drops 
of water. Stir till melted and smooth. Add the zinc or other 
agent with a few drops of water if necessary. Mix carefully, then 
cool and mould rapidly into pencils. 

In certain cases where there is simply morbid enlargement of 
the os (as sometimes in chronic metritis) without ulceration, this 
engorgement may often be reduced by inserting some iodide of 
potassium enclosed in a tampon of wadding. Placed in contact 
with the neck, this substance generally produces a slight ulceration 
which rapidly heals, and is followed by a diminution of the organ. 
After eight or ten days, it may be repeated. 

In cases of vegetations and rebellious ulcerations, more potent 
agents are required. Of these chromic acid is ranked by some as 
one of the best. It produces a dry, yellowish eschar. The crystals 
are used, being applied directly against the part, until the whole of 
it is covered with the eschar. It is not uncommon for this appli- 
cation to be followed by vomiting and diarrhea, and precautions 
must be taken that as little of it as possible be absorbed into the 
system. 

Caustic potassa, Canquoitis paste, Vienna paste, and Filhos 1 caustic, 
are other powerful caustics occasionally applied. They should be 
used with great caution. Dr. Filhos' caustic is a solid form of 
Vienna paste, and is more manageable than it. Nitric acid is con- 
venient of application, and has furnished good results. The acid 
nitrate of mercury is apt to extend beyond the diseased structures, 
and is. said to leave troublesome cicatrices. It has, however, been 
especially recommended in syphilitic ulcerations of the os. 

In that form of cervicitis accompanying chronic metritis, where 
the cervix is enlarged, infiltrated, softened, and generally more 
or less ulcerated, as well as in a later stage of the same morbid 
process, when the cervix is enlarged, thick and hardened, the ac- 
tual cautery will usually furnish the best results. This may be 



108 DISEASES OF THE UTERUS AND ITS ANNEXES. 

applied as the hot iron, the thermo-cautery, the galvano-cautery, 
the gas cautery, or the cauterizing pencils. The application of the 
red-hot iron is not at all painful. It is followed by an eschar which 
is detached after eight or ten days, leaving a healthy granulating 
surface, and is not followed by a contracting cicatrix. The iron 
should be nearly at a white heat in order to prevent the adherence 
of the tissues which takes place when it is at a dull red. 

Of the other methods of cautery mentioned, the cauterizing pen- 
cils of M. Bonnafond may be described. They are little cylin- 
ders made of powdered charcoal and nitre, as follows : 

138. ty. Nitrate of potassa, 2 grammes 

Powdered wood charcoal, 30 " 

Gum tragacanth, 10 " M. 

Or, as follows : 

139. I£. Nitrate of silver, 1 gramme 

Wood charcoal, 28 " 

Powdered acacia, 4 " 

Water, q. s. M. 

They are lighted at a candle and applied to the part ; but as they 
are at once extinguished by the application, they are suitable only 
when superficial eschars are desired. 

Cauterization by ignipuncture has been advised in this form of 
cervicitis when very rebellious. Filiform cauteries are used, and 
are inserted into the tissues to the depth of four to eight millimet- 
res. Four to six punctures are made, distributed over the lips of 
the os. 

After the cautery has been applied, the vagina should be washed 
with cold water, and the patient keep her bed for the rest of the 
day. 

DR. T. GAILLARD THOMAS, NEW YORK. 

The cardinal point is to look upon the ulcer as a local manifes- 
tation of diseased action in the cervix or body, which is the 
lesion to be treated. The ulcer is a symptom of a graver and 
more important morbid state, which must be kept in view. It 
often happens that one symptom of a disease so distresses the pa- 
tient that the remedy must be addressed solely to it ; as when 
the ulcer by its profuse discharge calls for prompt relief. When 
the ulceration results from inflammation confined to that part of 
the cervical tissue immediately underlying it, the relief of the 



CERVICITIS. 109 

ulcer by the alterative and counter-irritant action of the means 
adopted, may effect the cure of the disease producing it, and the 
fact of the existence of such disease may not be recognized. "But 
when it depends upon the irritation of the discharges from the cav- 
ity of the cervix or the body of the uterus, or upon deep-seated 
areolar hyperplasia, cure is more difficult." 

Caustics will be quite sufficient for ordinary granular degenera- 
tion, but when there are exuberant development of villi, so-called 
cock's-comb granulations, it is well to snip these growths closely 
by a pair of long-handled scissors, or even to scrape them off 
smoothly with a curette, and then apply the caustic. Of these, 
Richardson's styptic colloid is excellent. It is a direct alterative, 
and forms a protecting crust over the ulcer. 

Where there is eversion of the cervix, the hemorrhoidal mem- 
brane may be removed as above, and the actual cautery, or the 
nitrate of silver applied. An excellent method of cauterizing these 
ulcers is the gas jet cautery of Acosta, of Paris. An ordinary 
rubber bag is filled with carburetted hydrogen from the gas jet ; a 
blow-pipe is fitted to the end of a tube attached to the bag, the 
escape of the gas being prevented by pinching the tube. The bag 
is compressed, the gas ignited, and the tiny flame is applied 
through the speculum to the spot. 

After such treatment the patient is to be kept in bed, and the 
parts copiously irrigated two or three times a day ; glycerine, 
laudanum, or infusion of bran or linseed, may be used. In a week 
or ten days, according to the potency of the caustic, the slough 
has separated. If the surface appears healthy, the milder alter- 
atives are to be employed, as a pledget of cotton, saturated with 
equal parts of glycerine and solution of subsulphate of iron, or 
glycerine f.ovj and tannic acid f.5ij. In addition, the patient should 
inject each night and morning a gallon of warm water, contain- 
ing an ounce of glycerine and a drachm of sulphate of zinc ; or 
two drachms of sulphate of alum, acetate of lead, or tannin, for 
ten or twenty minutes. Medicated suppositories may be used, of 
zinc oxide; or sulphate of alum, gr.iij ; or ung. hydrarg., gr.x; or 
plumbi iodidi, gr. v; or acid tannic, gr.ij. And, as an anodyne, 
may be added to either of these : ext. belladonnas, gr.j ; or pulv. 
opii, gr.ss. These articles may be made into a mass with tragac- 
anth, starch, slippery elm, and glycerine, and covered with cocoa 
butter. 



IIO DISEASES OF THE UTERUS AND ITS ANNEXES. 

When needed, the caustics may be repeated, but not too fre- 
quently, time should be allowed for the development of their stim- 
ulant effect; once a fortnight, or even once a month. 

In follicular ulcer, evacuate the cysts and cauterize their cavities 
thoroughly by nitrate of silver, chromic acid, or the acid nitrate of 
mercury. 

DR. T.OMBE ATTHILL, OF DUBLIN. 

The first step in the more acute forms of inflammation of the 
cervix is to relieve the congestion by puncturing the cervix. The 
point of the knife should penetrate from y% to J^ of an inch # 
When the lining membrane of the cervix is extensively implicated, 
the next step is to apply strong nitric acid freely to the whole in- 
terior of the cervical canal. The acid is introduced on cotton 
wrapped around a platinum probe, and care must be exercised that 
it does not touch the walls of the vagina. This may be followed 
after a few days by the glycerole of tannin, applied in a similar man- 
ner ; or the glycerole may be used instead of the acid. 

140. fy. Acidi tannici, gr.x 

Glycerinae, £§j. M. 

Thoroughly saturate a pledget of cotton with this, and then 
attaching a piece of string to facilitate its removal, introduce it up 
to the os uteri through the speculum, and leave it there for twenty- 
four hours. This is often productive of great benefit. If much 
irritation exist in the vagina, omit the tannin and use plain glycer- 
ine. 

When the cervix is greatly engorged, cedematous, and covered 
with papillae, sometimes the above procedures fail, and nothing 
promises relief but the total destruction of the diseased surface by 
caustic potash. Whenever this caustic is used, it should be applied 
through a glass speculum, and rubbed freely against the part ; a 
pledget of cotton saturated in vinegar should be previously inserted 
between the lower lips of the os uteri and the edge of the specu- 
lum, so as to neutralize any of the potash which may escape ; and 
the vagina should be washed out with vinegar immediately after 
the application. The patient should remain in bed several days. 
When much induration exists, the potash may have to be applied 
several times. 

Milder applications are nitrate of silver and tincture of iodine. 
The latter seems to allay the backache so much complained of in 
these affections. 



CERVICITIS. I 1 1 

The actual cautery, either the hot iron or charcoal pencils 
(F. 137), are also valuable aids in obstinate cases. Iodized cotton 
may be introduced into the cervix as recommended by Dr. Green- 

HALGH. 

DR. KCEBERLE. 

In the Annates de la Societe de Medecine de Gand, M. Kceberle 
prefers chromic acid as a cauterizing agent to the other remedies 
usually used, as pernitrate of mercury, iodine, nitrate of silver, and 
the actual cautery. He uses it in the crystalloid condition. It is 
a very anhydrous substance, and readily absorbs the moisture from 
the tissues which it may touch. M. Kceberle applies it through 
an India-rubber speculum s on a tampon of cotton-wool. Vomiting 
often supervenes within fifteen or twenty minutes from the applica- 
tion of the acid. When the tissues are seriously altered, it is nec- 
essary to repeat the cauterization, but M. Kceberle has hitherto 
found three applications to suffice. After the application he ap- 
plies a tampon, and advises the patient to use two soap and-water 
injections daily. He treats all ulcerations of the os in this way, 
as in epithelioma. 

DR. ROBERT BELL, OF GLASGOW. 

This writer, in the Lancet, Aug. 10, 1878, describes a very suc- 
cessful and simple mode of treatment of those cases of papillary 
ulceration of the cervix, in which on examination the vaginal 
mucous membrane is found to be turgid and red, and unduly sen- 
sitive to the touch. The vaginal portion of the uterus is hyper- 
trophied, and around the os the finger detects a sponginess of the 
mucous membrane, and the lips are everted. On introducing the 
sound, hemorrhage to a small extent is induced. The uterine 
canal measures three inches. The speculum reveals a granular 
ulcer extending both outwardly and inwardly from the external os. 
This has evidently been due, in the first place, to erosion of the 
papillae, which, by continued irritation, has developed into this 
granular condition. The slightest touch causes it to bleed very 
freely. 

The treatment commonly employed in such a case is the uterine 
douche night and morning, which the patient uses herself, while an 
application twice a week of a moderately strong solution of nitrate 
of silver is made by the physician. 

Dr. Bell finds he can effect a cure in half of the time by another 



112 DISEASES OF THE UTERUS AND ITS ANNEXES. 

method. All the discharge is wiped away by means of cotton- 
wool, and then pure tar is applied to the diseased surface on a 
pledget of cotton. This is allowed to remain in contact with the 
ulcerated part for twenty-four hours at least, when the patient with- 
draws the cotton by means of a piece of string which has been 
left for the purpose. The application is made twice a week, and in 
from two weeks to a month the cure is complete. The tar is made 
fluid by the addition of one part of rectified spirits to eight parts 
of pure tar. This application has another great advantage besides' 
its healing properties : it acts as an anodyne ; and then a further 
benefit is derived from the support which the pledget of cotton- 
wool gives to the enlarged uterus. 

DR. ROBERTS, MANCHESTER, ENGLAND. 

In ulceration of the os, this writer, while commending the carbolic 
application, does not consider the strong acid necessary in super- 
ficial ulceration. A mixture of one part of the strong acid with 
two of olive oil seems to answer all ordinary purposes ; but in 
cases of very deep ulceration the use of the strong acid may be 
called for. In such cases, Dr, Roberts desires the acid to be 
liquefied by the addition of a very small quantity of water. This 
has not been found always to answer the purpose, but it has been 
noted that the addition of a few grains of camphor will dissolve 
the acid, and will, moreover, prevent it again becoming solidified,, 
even at a freezing temperature. The application of the carbolic 
oil to the os uteri is best effected by soaking a little cotton-wool 
in the liquid, securing it by a string, and introducing it through a 
speculum, the string being left depending out of the vagina, and 
the patient being directed to pull it away on the second day. 
This procedure is repeated in ordinary cases about twice every 
week. If it be desired to apply the acid to the cervical canal, it 
may readily be done by passing in a gum-elastic catheter smeared 
with the carbolic oil. 

DR. J. M. BENNETT, OF LIVERPOOL. 

Interstitial Injection. In chronic cervical metritis (enlarged os, 
inflammatory enlargement and induration of the os), this writer 
{Lancet, Nov. 2, 1878), has tried with gratifying results the inter- 
stitial injection of iodine. 

He first prepares the patient both generally and locally ; the lat- 



CERVITICIS. I I 3 

ter by relieving any super-engorgement by means of local deple- 
tion, carried out by means of cupping, the frequent use of warm 
water, and the application of glycerine, so as to induce osmotic 
action, care being taken to avoid the period of menstrual excite- 
ment. He then uses a simple modification of the hypodermic syr- 
inge, which is sufficiently long to be used with Ferguson's specu- 
lum ; its points are made of eighteen-carat gold; and the other 
portion, which might come in contact with the iodine, bromine, or 
other agent inimical to any metal less resistant than gold or plati- 
num, is mercurially gilt. The instrument should be charged with 
a solution composed as follows : 

141. I£. Potassii iodidi, 

Potassii bromidi, aa gr.x 
Tinctune iodinii, f.3ss 

Aquam destill., ad. f.3ij.. M„. 

He then either punctures through the speculum, leaving the- 
uterus free if the os and cervix be very large and low down, or 
fixes it with Sims's tenaculum, using a duckbill speculum. He 
generally makes from three to five punctures, according to the 
amount of hyperplastic matter to be absorbed. A cotton pledget 
well soaked in glycerine is placed against the part, and rest en- 
forced for at least twelve hours. Seldom more than three opera- 
tions are required ; and he has never found any disturbance of 
moment set up, either generally or locally, by the procedure ; on 
the contrary, a number of cases turn out successfully when other 
methods have proved unavailing. 

Internally he uses the bromide of potassium in large doses, both 
for the purpose of quieting excitement, and secondly of obtaining 
some of the benefits described by Prof. Binz, of Bonn, who speaks 
of the potash salts as being positively specific in subinvolution; 
and he believes he has many times seen advantages derived from 
a continuous use of this salt, quite equal to those described by. Dr. 
JR.. Williams, who attributed such wonderful powers to its action 
in splenic hypertrophy. 

The above treatment can usually advantageously be joined to 
dilatation of the os by means of a sponge tent, after the first effect 
of the injections has passed off. 

Richardsoji's Styptic Colloid. According to Dr. R. E. Beach, of 
Illinois (Illinois Medical Recorder, Aug., 1878), in granular condi- 
tions of the os, Richardson's styptic colloid painted over the os; 
8 



I 14 DISEASES OF THE UTERUS AND ITS ANNEXES. 

seems to produce good results. " It appears to act as a direct alter- 
tive, and by forming a protective crust over the surface, constitutes 
for it a shield against friction and uterine discharges, and by its 
constringing effects diminishes local congestion. (For the prepara- 
tion of the styptic colloid, see Napheys' Surgical Therapeutics, 
sixth ed., p. 114.) 

DR. HALTON, OF DUBLIN. 

In the Dublin Journal of Medical Science, June, 1876, Dr. Hal- 
ton gives a number of cases, explaining his plan of treatment 
which consisted in producing local congestion by local means 
and touching the excoriated surface with the strong nitric acid. 
This was always carried into the cervix when that appeared dis- 
eased, and the acid brought in contact with the whole surface of 
the canal, and even to the fundus if necessary.* It never gave 
rise to the slightest symptom of danger or distress, and in the vast 
majority of instances was altogether unfelt. When pain did occur, 
its amount was so trifling as to attract little notice from either the 
patient or physician. Astringent injections were found to be of 
little use, and whether this was from the patient's awkwardness in 
managing them or not, they have been latterly dispensed with 
by him, and their place supplied by the tannin, pessary, or bougie 
placed in contact with the os or introduced into the canal. The 
skin of the abdomen has been leeched or blistered, as seemed 
most suitable, over the tender spot in the region of the ovary, 
with very marked benefit. When much leucorrhiea was present, 
small blisters to the sacrum were found servicable, while ergot 
and Indian hemp were useful internally, particularly when hemor- 
rhage was present ; but, undoubtedly, the most generally effective 
drugs were strychnine, in small doses, in combination with dilute 
nitric acid. The following is the formula used : 



J42. ^. • Liquor of strychnine, f.3iss 




Dilute nitric acid, f.3ij 


• 


Tincture of gentian, fjss 




Hoffman's solution, . f-3iij 




Water, q. s. § .viij. 


M. 


The dose is one tablespoonful thrice daily, before meals. 


If pyrosis 



*It is by no means necessary in all cases to dilate the os before touching 
the interior of the uterus with nitric acid. In many cases where this becomes 
necessary, the canal of the cervix is sufficiently patulous to admit the stillette 
covered with cotton-wool soaked in this agent. 



CERVITICIS. 115 

. is present, a drachm and a half of sedative liquor of opium added 
to the above for a week or two, taking care to regulate the bowels 
with suitable aperients, will be found serviceable. 

MECHANICAL TREATMENT. 
T. GAILLARD THOMAS, M. D., NEW YORK. 

When eversion of the cervical mucous membrane is the result 
of injury, as in parturition, an operation is necessary. The edges 
of the fissure must be pared and approximated with deep sutures 
of silver wire. , 

A. J. C. SKENE, M. D., NEW YORK.* 

Some preparatory treatment is generally required, before the 
operation can be performed. The cervix is usually found gaping, 
enlarged, eroded from pressure on the pelvic floor, and often in a 
state of cystic degeneration. In a bilateral laceration extending 
nearly, or quite, to the vaginal junction, the eversion of the parts 
is often so great as to require the removal of large portions of 
their surfaces before bringing them into apposition, or the tension 
on the sutures will be so strong as to cause them to cut into the 
tissues and prevent perfect union. 

In these cases, about ten days before the final operation, bring 
the parts together, without any freshening of their surfaces, and 
confine them by means of a small piece of sheet lead on either 
side of the cervix^ held in position by a silver suture passed con- 
tinuously through both ends of the leads. Then tampon the va- 
gina carefully with marine lint, which can be retained in situ for 
two or three days without becoming offensive, thereby protecting 
the surrounding parts from the chafing of the clamp. At the end 
of a week, remove the clamp. Three days later, operate. 

The use of the marine lint tampon, above referred to, is, even 
without the clamp, of service in reducing the abnormal condition 
of the lacerated cervix. 

He prefers the ordinary silk suture, as it cuts the tissue much 
less than silver wire. This is easily'tied by using Carroll's knot 
ties, or by passing a loop of the Thomas curette, and making 
traction laterally with that, holding the other thread firmly in the 
fingers. For after-treatment the less they are interfered with, the 
better. Remove the tampon in forty-eight hours, and do not use 
the vaginal injection unless absolutely requisite. 

* Proceedings of Kings County Medical Society, June, 1878. 



Il6 DISEASES OF THE UTERUS AND ITS ANNEXES. 

TENTS FOR DILATING THE CERVIX. 

The use of tents of any kind is not without danger. Serious 
maladies and death have at various times resulted from their in- 
sertion. Dr. T. Gaillard Thomas gives the following rules with 
regard to their employment : 

Rule i. — In the introduction of a tent, no force whatever should 
be employed. Should that first essayed not pass the os internum 
easily, it should be withdrawn and either bent so as to follow more 
accurately the course; of the cervical canal, as ascertained by the 
probe, or exchanged for a smaller tent. 

Rule 2. — A tent should never, under any circumstances, be in- 
troduced at the physician's office, and the patient allowed to go 
home with it in utero. Such practice is hazardous in the extreme. 
Even when introduced at the patient's home, she should at once 
be confined to the bed. 

Ride 3. — The practitioner should always investigate as to the 
previous existence of chronic pelvic peritonitis, one of the most 
common of the diseases of women. Should it have existed, tents 
should be carefully avoided. 

Rule 4. — A tent should never be allowed to remain in the uterus 
more than twenty-four hours ; and, if it be compatible with the ac- 
complishment of the desired result, it should be removed in twelve 
hours. 

Rule 5. — After the removal of a tent, the vagina should be 
washed out with an antiseptic fluid, and if any pain, chilling or 
discomfort, follow the removal, opium. should be freely adminis- 
tered and perfect rest enjoined. 

Rule 6. — After the removal of the tent, the patient should be 
kept in bed at least twenty-four hours, and never allowed to travel 
before the expiration of four or five days. 

Dr. Tilt lays stress on the importance of examining the patient 
with a speculum in full daylight, to be sure nothing is amiss with 
her pelvic organs. A tent should only be introduced every third 
or fourth day, and at some days remove from the menstrual epoch. 
If much irritation is produced, the dilatation should be suspended. 
Vaginal injections should be used with great care at this, time as 
severe uterine colic may result from the fluid entering the dilated 
os. 

Dr. B. S. Schultze, of Jena, {Central-blatt fur Gynezkologie, 
Nov. 7th, -1878), uses sea-tangle tents with strict antiseptic precau- 



CERVITICIS. 117 

tions, and having succeeded without an accident in several hundred 
cases, believes that if his method is followed the usual contraindi- 
cations to dilatation of the cervix may be dispensed with. One 
principle of his procedure is the assumption that for safe dilatation 
the tangle tent must never come in contact with a raw wound sur- 
face. But, besides this, he takes the strictest antiseptic precautions 
that the conditions of the operation allow of. He first employs 
flexible copper sounds, of varying thickness, by which he ascer- 
tains the exact size and curvature of the cervical cavity. Having 
settled these points, a tangle tent, corresponding in thickness with 
tue sound, which just passes the cervical cavity, is immersed for 
one or two minutes in boiling water, and being thus rendered flex- 
ible, the same curvature is given to it as that of the sound, which 
has been previously adapted to the cavity of the uterus. On cool- 
ing, the tent retains the curvature thus communicated to it, and 
after steeping it in a T -| ¥ solution of carbolic acid, it is introduced 
through a speculum, the cervix being meanwhile held down by an 
assistant with a hook or vulsellum. If a drop of blood is seen 
coming from the cervix during any of these processes, the opera- 
tion is to be postponed for at least twenty-four hours. The patient 
is to be kept strictly at rest during the whole time that the tent is 
dilating, and the strictest care is to be taken in the removal of the 
distended tent that no injury is caused to the cervix. The vagina 
and cervical canal ought to be then carefully washed out with a 
T f ¥ solution of carbolic acid. 

It is remarked by Dr. W. Goodell, that the danger of inserting 
tents increases with each introduction. Hence the importance of 
dilating the canal with one or at most two introductions. When 
sponge or laminaria is used, the cervix should be irrigated every 
few hours with a strong solution of table salt or of chlorate of 
potassa. 

RESUME OF REMEDIES. 

AGENTS APPLIED TO THE OS. 

Acidum Aceticum, in crystals, is said to be but slightly painful and very 

efficient. (See page 106 ) 
Acidum Bichloraceticum, has been recommended by Schmidt & Urner. 

It is obtained by the action of chlorine on hydrated acetic acid 

under the influence of the solar rays. 
Acidum Carbolicum, in crystals, is an efficient agent, and as it is also a 

local anaesthetic, the pain is less prolonged than with the min- 



I 1 8 DISEASES OF THE UTERUS AND ITS ANNEXES. 

eral acid. Galabin considers it the most widely useful of all 
applications for the cervical canal. The vagina must be pro- 
tected and well- washed out after the application. 

Acidum Chromicum is preferred by Dr. Kceberle for the reasons given 
(page in). It is also a favorite with some American practi- 
tioners. Dr. Atthill says it is more irritating than nitric acid. 

Acidum Nitricum is preferred by A. Court y and others to any other 
caustic. Dr. Atthill has especially advocated it in Great 
Britain. 

Acidum Pyroligneum was used largely by Scanzoni and the Vienna 
school. 

Alumen, in powder, or ointment, or strong solution, or as burnt alum, has 
been occasionally employed. 

Anti?no?iii Chloridum is an energetic caustic,- but of uncertain action. 

Argenti Nitras has long been the most popular of all caustic applications 
to the os uteri. Dr. Tilt observes: "I have no hesitation in 
saying it is the most valuable of all the agents that enable us to 
cure inflammatory affections of the reproductive mucous mem- 
brane." His usual solution is gr. xl to aquae f.5j. He applies 
it every four or five days when the os is red and sensitive, as 
well as when ulceration is present. 

Bismuthi Subnitras. Dr. A. Courty {Maladies de V Uterus, 1866), 
considers this substance, insufflated upon the part, one of the 
most powerful modifiers of ulcerations of the os. It has also 
been very strongly recommended, made into a thick cream with 
glycerine, applied to ulcerations of the os. It may be con- 
veniently introduced through a tube, and retained in place by a 
pledget of cotton. 

Creasotum was formerly used, but carbolic acid has taken its place. 

Cupri Sulphas is a favorite agent with the Swedish physicians. They 
claim it is curative, and not followed by troublesome sequelae. 

Fcrri Chloridi Tinctura. For hemorrhage depending on a granular con- 
dition of the cervix, this is a valuable agent. It is best applied 
on a small roll of cotton saturated with it, another and larger 
roll wet with glycerine being placed outside it (Atthill). 
They should not be left over a few hours, or sloughing may en- 
sue. Aran applied to ulcers of the os the following glutinous 
compound : 

143. ]£. Tinct. ferri chloridi ether., 

Collodion, aa equal parts. M. 

Ferri Subsulphas has been largely employed as a styptic, especially in the 
form of Monsell's solution. 

Hydrargyri Nitras. The acid nitrate of mercury is well spoken of by 
Tilt and other practitioners. It must be applied with consid- 
erable care, so as to avoid injuring other parts, and a solution of 
bicarbonate of soda should be at hand to neutralize it. On the 
other hand, Atthill never employs it, and A. Courty {Mala- 



CERVITICIS. 119 

dies de V Uterus, 1866) formally condemns it as difficult of man- 
agement and liable to be followed by severe mercurial poisoning. 

lodinium. In ulcers of the os, iodine is not so effective as nitrate of sil- 
ver (Tilt), but when the latter disagrees, tincture of iodine is 
the best application. To the simple tincture Dr. Goodell pre- 
fers the saturated ethereal tincture 

Iodof annum is a soothing and healing application, principally objection- 
able from its odor and the unpleasant taste it imparts. 

Pix Liquida has been employed by Bell. (P. 112). 

Potassa Fusa. This is principally used in the form of potassa fusa cum 
cake, which is of two strengths, known respectively as, 
Filhos' caustic : 

144. $, Potassae fusae, 1 part 

Calcis^ 2 parts. 

Melt together. 

Bennett's caustic : 

145. fy. Potassae fusae, 2 parts 

Caleis, 1 part. 

Melt together. 

Dr. Tilt says that in obstinate cases of unhealthy condition 
of the lining membrane of the cervix, in highly irritable ulce- 
ration of the cervix with soft hypertrophy, in pseudo mem- 
branous ulceration of the neck, and to establish an issue on 
the healthy mucous membrane covering a hard hypertrophied 
cervix, these preparations are exceedingly useful. Dr. Atthill 
finds the caustic potash eminently useful in those cases where 
the os uteri is in a state of granular erosion. 
Potassii Iodidum acts as a moderate caustic in certain cases. (See page 
107.) 

Tannicum Acidum is frequently employed as a stimulating application. 
It may be made into a crayon by moistening with glycerine, 
rolling out, and drying. 

Zinci Chloridum. This agent is a very painful one. 

Zinci Sulph is. In the more chronic stages of cervical endometritis, solid 

points of fused sulphate of zinc have been introduced by Dr. 

Braxton Hicks, and are often useful, but are liable to cause 

considerable pain and irritation when any active hyperemia is 

present. 

uterine tents. 
Allhea. The root of the marshmallow has been employed as a tent. 
Cloth. Tents made of cloth were introduced in 1871, by Dr. V. H. 

Taliaferro, of Georgia, {Jour. Gyn. Soc, Boston, Vol. V.) 

and have been advantageously employed. 
Corn-stalk Pith. In the Transactions of the Medical Association of 

Georgia, 1878, Dr. \V\ T. Goldsmith urges many reasons for 



IJO DISEASES OF THE UTERUS AND ITS ANNEXES. 

the use of this substance for tents. Take a joint of dried 
corn-stalk; strip it of its cuticle, and compress the pith, 
slowly and firmly, between the thumb and index-finger. By 
continued pressure, it is reduced to four or five times less than 
its original size. It has a dilating power equal to sea tangle or 
sponge. The corn-stalk tent is of easy introduction Its rig- 
idity overcomes any slight resistance. Dr Goldsmith has used 
this tent for the last seven years. He has not had a single acci- 
dent from its use, although he has introduced the tent many 
hundreds of times. The advantages of this corn stalk tent are 
that it dilates effectually, but not too rapidly. It is smooth, soft, 
and can be removed without force. It produces no lacerations, 
abrasions, or irritation of the mucous membrane. It can be 
medicated with any substance as easily as the sponge or cloth 
tent. It is of vegetable origin, and hence does not become 
putrid and poisonous to the patient, and it may be retained, 
non-compressed, for days without injurious results, if no pain 
occurs. 

Gentian Root. French physicians have used this occasionally. It does 
well as a dilating agent. 

Ivory, which has been softened by exposure to acids, is recommended by 
some. In twenty-four hours it swells to double its first size. 

Laminaria or Sea Tangle. This aquatic plant swells, when moistened, to 
three times its size when dry. It has the advantage over sponge 
that it contains no animal matter, and emits no fetor. When 
perforated from end to end as recommended by Dr. Green- 
halgh, such tents dilate rapidly and also allow the fluids of the 
uterine cavity to escape. They cause, however, much severer 
pain than sponge, and run a danger of tearing a resisting os. 
Mr. Tait disapproves of them for these reasons. 

Slippery Elm Bark. This substance is praised by Dr. Wm. Goodell as 
a material for tents. Though of less expansive power than la- 
minaria or sponge, it may be left in longer as it softens down, 
and becomes dissolved by the discharges. It is of especial value 
in cases requiring no very great dilatation, but a prolonged 
treatment, such as in flexions, 

Sponge. This is the substance preferred by many for tents. Its expan- 
sive power is considerable and it is easily adjusted to the size 
and shape of the neck. But it produces a fetor which is but 
partially overcome by treatment with carbolic acid and irriga- 
tion of the vagina. Tait prefers sponge tents, impregnated 
with oil of cloves, but adds that even with these there is some 
risk of infection, and to secure entire immunity recommends 
that the tent be enclosed within an elastic capsule. 

Tupelo. The root of the tupelo tree, JVyssa-multiflora, has been ad- 
vocated by Dr. G. E. Sussdorf, of New York city. It is light, 
smooth, and its power of absorption is said to be greater than 
that of sea tangle. 



CERVITICIS. 121 

OTHER MEASURES. 

Galvanism. In ulcerated os with leucorrhea, Dr. O. E. Herrick, of 
Greenville, Michigan, writes to the New York Medical Record, 
1879, extolling this line of treatment. He introduces a pessary, 
made of a ring covered with rubber and supported by a Y- 
shaped support of twisted silver wire, held up by a perineal 
band. Outside, and held up by the waist-band, is a small plate 
of zinc, enclosed in a a chamois-skin bag with a sponge moist- 
ened with vinegar. The zinc plate is united to the silver wire 
of the pessary by a copper wire, thus making a complete gal- 
vanic battery. In one patient, in thirty six hours after the gal- 
vanic attachment was made, he found healthy granulations in- 
stead of the unhealthy ulcer ; and the leucorrhea had stopped 
almost entirely, which -had not taken place for a year before. 
In one week, thereswas neither ulceration nor leucorrhea; he 
then removed the copper wire and zinc, but left the uterine 
supporter a week longer. The patient was discharged cured, 
and remained so after the removal of the apparatus. 

Local Blood-letting. Prof. J. Y. Simpson says frequently where there is en- 
gorgement or hypertrophy, the abstraction of two or more ounces 
of blood greatly relieves the stress from which the patient is 
suffering, and aids in the beneficial results from other remedies. 
This may be effected by leeches applied to the cervix through 
the speculum, or by scarifying around the os with a tenotomy 
knife with a long stem. It is well to make the patient sit over 
a dish of hot water to favor the flow, and then apply a warm 
vaginal douche, taking care that the patient is not wetted and 
chilled during the process. 



DISPLACEMENTS. 

PROF. E. J. TILT, LONDON. 

Displacements of the uterus would seldom require mechanical 
treatment if the congestion, and other affections were properly 
treated. It is bad practice to employ mechanical measures prior 
to the cure of inflammatory lesions. This, by diminishing enlarge- 
ment, will likewise relieve displacement. The stem pessary will 
not be borne, when the cervical mucous membrane is inflamed. 
When the displacement is congenital or of long standing, the cure 
of the inflammation does not correct it, but by a tonic treatment, 
with opium suppositories at night, astringent injections, and elec- 
tricity, many are enabled to perform their household duties. Al- 
ways make light of displacements to the patient, as otherwise 
fright interferes with the cure. 

Retroversion and anteversion depending greatly upon relaxation 
of the vagina, astringent injections prove of value, as strong solu- 
tions of alum, sulphate of zinc, or tannin. Aid is obtained by 
suppositories containing alum, iron alum, tannin, or matico. A 
good plan is to enclose in cotton wool a small lump of alum, the 
size of a hazel-nut, tie round it a string long enough to hang out 
of the vagi'na, then place £he alum ball as high as possible in the 
vagina. The wool imbibes the fluids, the alum gradually dissolves 
and acts powerfully on the vaginal walls. Remove the wool next 
day and irrigate the vagina freely to remove the coagulated mucus, 
prior to a second application. Cold vaginal douches are often use- 
ful, applied twice a day, for fifteen or twenty minutes. Douching 
the loins, while the patient is perspiring from a vapor bath, often 
relieves the pains of displacements. 

Prolonged repose is hurtful, though rest, for a few hours daily in 
the recumbent posture will diminish pain and congestion. Con- 
sider the periods of menstruation as seasons of disease, and enforce 
complete rest, with the use of hip baths and large abdominal 
poultices. Parturition generally greatly modifies and even cures 
uterine displacements. They are then mechanically rectified, and 
the active nutrition furnishes sounder tissues. Hence, after partu- 
rition, in such cases keep the patient on her back longer than 

(122) 



DISPLACEMENTS. 1 23 

usual, and employ twice daily after the red lochia have ceased, as- 
tringent injections, and continue them for months. 

When adequate improvement does not follow constitutional 
treatment, mechanical means may be employed. The womb may 
be placed at rest by a hypogastric bandage with a vertebral sup- 
port. It takes off the pressure of the intestines. Prolapsus and 
procidentia may be greatly relieved by the styptics as above. 

In case of complete prolapse, when the womb can not be re- 
placed, its volume may be diminished by scarifications and lead 
lotions, or when necessary by strapping it with strips of adhesive 
plaster until its size is reduced. Then, with the patient in the 
genu-pectoral position, the, surgeon may force the womb back into 
the pelvis. 

Globular pessaries of boxwood or vulcanized rubber are often 
useful, and may gradually be reduced in size, till they can be 
omitted. The air pessary will often give great relief, even though 
it does not cure the displacement. 

All pessaries should be occasionally removed and cleansed. 

A pessary made of rubber covered watch-spring is easy of in- 
troduction and tends to counteract the relaxation of the vaginal 
walls. A heavy prolapsed womb is well supported by Coxeter's 
gutta percha pessary, which resembles a funnel, the mouth covered 
with thin vulcanized rubber on which the womb rests. This mem- 
brane is pierced with holes to permit the secretions to drain off 
freely. Another by Coxeter has a spring which distends a thin 
rubber cup which supports the womb ; the lower end is fixed in 
the perineal band, so that the patient can remove or draw it aside. 
Bourjeaud's mushroom pessary is made of vulcanized rubber and 
may be inflated by a tube after it is placed. When distended, it is 
well calculated to support the neck of the womb in the depression 
in its upper part. It is secured by elastic bands fastened to an 
abdominal belt. It has two advantages, its size may be regulated, 
and it diminishes vaginal irritation. 

In complete prolapsus, the tow-pessary may be employed. The 
vagina, after replacement, is packed with carded oakum, called 
" antiseptic marine lint," or with chloralum cotton wool. The va- 
gina is allowed a limited power of contraction, the pressure does 
not cause pain, and the pessary is not readily displaced, nor does 
it interfere with the functions of the surrounding organs. The 
plug should be replaced weekly, less being required each time. 



124 DISEASES OF THE UTERUS AND ITS ANNEXES. 

This is highly praised by Dr. Copeman of Norwich and Mr. 
. Morgan of Litchfield. 

Various plans have been proposed to narrow the vagina, and 
thus cause the womb to be retained. 

Dr. Marion Sims cuts off slips of mucous membrane at appro- 
priate distances, and brings the cut surfaces together by silver 
sutures. 

When old adhesions, prevent the reposition of the womb, 
Edwards of Denbigh and others propose its removal. In three- 
fourths of these cases, the operation has been followed by recovery. 

For uterine flexions, Dr. Goodell, of Philadelphia, introduces 
into the cervix a powerful dilator and forcibly dilates it, so as to 
crack the circular fibers. This is done under ether, and is claimed 
to be very successful. 

LOMBE ATTHILL, M. D., DUBLIN, 

In retroflexion believes that where a pessary can be borne, its 
action will aid the cure. He prefers Hodge's lever pessary with 
transverse bars; or Dr. Greenhalgh's spring pessary, which is 
made of copper wire bent like the Hodge pessary, cased in rubber 
tubing ; but the wire is wanting at the lower or wide end, the tubing 
alone crossing there. A double advantage is that the tubing here 
adapts itself to the parts and does not irritate the neck of the 
bladder, and also it permits the sides to close during introduction. 
Great care is requisite in adjusting the pessary as to its size. When 
too large it causes pain, when too small it slips out. Stem pessa- 
ries are especially useful in dysmenorrhcea with retroflexion. 
The best is Greenhalgh's flexible pessary ; the stem is of rubber 
tubing, admitting an ordinary sound, which must be passed into 
it when being introduced. Near the upper extremity is a bulb 
with four slits in it, through which the secretions escape, the lower 
extremity terminates in a shield. 

Stem pessaries should never be left in longer than a month, and 
should be avoided if possible. 

Bear in mind that cases are often met with which seem to cause 
no distress, and should not be interfered with. 

Retroversion is rare, and is generally connected with pregnancy 
and usually occurs at the close of the third month, causing reten- 
tion of urine; on emptying the bladder, a globular body will be 
found occupying the hollow of the sacrum, while the os uteri is 



DISPLACEMENTS. 125 

high up behind the pubes, and the fundus will be found absent 
from its proper place. 

Two indications are to keep the bladder empty, and to restore 
the uterus to its normal position. In these cases always use a long 
gum catheter. If the attempt to restore the womb cause great 
pain, it is better to wait a few hours, and calm excitement by a 
suppository of morphia. Place the patient on her side, or better 
in the genu-pectoral position, and with two fingers in the vagina 
press the fundus up laterally so as to avoid the sacral promontory. 
In case this fails, introduce a Barnes' rubber bag into the rectum, 
distend it with water, and at the same time make pressure with 
the fingers in the vagina. Should all such efforts fail, abortion 
must be induced or deatri will result. After the reduction has 
been accomplished, the patient must be kept at rest, the bladder 
carefully emptied at proper intervals, and if the uterus again tends 
to fall, this must be prevented by keeping her in the recumbent 
position. 

Anteflexion is very common, and is generally the result of con- 
gestion, etc. Puncturing the cervix will alone often give marked 
relief. The fundus can be raised by means of the sound, and sup- 
ported by the stem pessary. 

Prolapse of the uterus must not be confounded with cystocele, with 
which it is often complicated. Absolute rest in the recumbent post- 
ure, even with the lower part of the couch elevated, is very useful, 
but after all, it is only palliative. Some support is required. The 
best is Hodge's pessary, a wide one with transverse bars. These 
bars prevent the anterior walls from prolapsing. Dr. Godson, of St. 
Bartholomew's, has invented a pessary with vulcanite wings, which 
are movable. The wings are closed on introduction and then ex- 
panded by bringing the metal feet together, where they are locked. 
This should be removed and replaced night and morning. In 
cases with large protrusion and greatly relaxed perineum, operative 
means must be employed to narrow the vagina. Sims removes a 
portion of the mucous membrane in the shape of a V from the 
anterior wall, the apex near the bladder, and the arms extending 
either side of the cervix. This opening is closed by means of 
wire sutures. In certain cases, it may be useful to repeat this pro- 
cedure on the posterior wall. 

Where the cervix is very long, relief may be obtained by its 
amputation by means of the ecraseur. 



126 DISEASES OF THE UTERUS AND ITS ANNEXES. 

Inversion of the uterus is rare, and generally occurs soon after 
delivery. In all cases, its reduction should be attempted by the 
taxis, under chloroform. Should this fail, continuous pressure ex- 
erted by a rubber bag in the vagina, inflated, and retained by a 
bandage will reduce it. 

All failing, it should be amputated by means of the ecraseur. 

THOS. ADDIS EMMET, M. D., NEW YORK. 

In all versions, correct the displacement by mechanical means, 
and relieve the local cause of disease. The latter should consist 
i n the frequent and continued use of hot water injections, etc. 
This gives tone to the blood-vessels. 

A retroverted uterus may be lifted into place.by the use of the 
index finger and is the most reliable means we can employ. It is 
attended with the least risk and we are able to appreciate at once, 
in case of adhesions, the point and extent of resistance. The pa- 
tient is to be placed on her back, the knees flexed, the hips drawn 
down to the edge of the couch. The index finger is introduced into 
the vagina, and the point of a tenaculum hooked into the posterior 
lip within the os. By this the organ is drawn toward the outlet 
so that the fundus may clear the promontory. This manipulation 
must be done with care, and if great pain is caused, it must be sus- 
pended. This manoeuvre causes a still greater retroversion ; to 
correct this, the perineum is to be pressed firmly back, that the 
finger in the vagina may be passed up far behind the uterus so as 
to lift that organ. The fundus thus elevated, the cervix is to be 
suddenly carried in an arc of a circle, downward and backward by 
means of the tenaculum. The version completed, the fundus can 
by the finger be pressed up against the uteri-sacral ligaments. 
These gape as the tension is relaxed by carrying the cervix back- 
ward, and the fundus slips between them. The finger is to be 
quickly passed from the posterior cul-de-sac against the anterior 
lip, the tenaculum withdrawn and the womb thrown forward by 
passing the finger repeatedly down the anterior face of the uterus, 
so as to press the cervix downward and backward into the hollow 
of the sacrum. This operation, especially when it has caused 
much pain, should be followed by a hot water injection, and a 
glycerine dressing in the vagina, and several hours' rest. 

On the subject of pessaries this author says: In adjusting a 
pessary great regard should be paid to the shape and size of the 



DISPLACEMENTS. \2J 

vagina, as scarcely two women could be benefited by the same 
instrument. The object is to restore the uterus to its proper place, 
and thus completely establish the circulation. Raise the uterus 
gently on the tip of the finger, until the patient expresses a feeling 
of relief from all feeling of fullness and bearing down. This is 
to be the guide. The pessary is then to be fitted so as to maintain 
the womb at this point. When the instrument fits properly, and 
has corrected the malposition, the patient should be unconscious 
of its presence. The largest number of cases will be relieved by 
some modification of Hodge's closed lever pessary. All outside 
appliances should except in extreme cases, be avoided. The in- 
strument should, remain unchanged for months, while the parts 
are recovering their tone. *^ Block tin rings made of an alloy of tin 
and lead in such proportions as to be easily moulded, and yet un- 
yielding enough for the pessary to keep its shape, make the best. 
The support for the instrument is to be taken from the bottom of 
the posterior cul-de-sac. Hard rubber may also be used for the 
same purpose. To receive the full benefit, the vaginal outlet 
should not be too large, and the posterior cul-de-sac should be of 
a natural depth. " The fulcrum of this double lever rests on the 
bottom of the cul-de sac, and in front against the posterior wall of 
the vagina. It should be curved at one extremity with reference 
to the shape of the cul-de-sac and posterior wall, and bent at the 
other end in the opposite direction with a lesser curve, so that it 
will be balanced, as it were, in the vagina." When the patient 
stands, the weight of the uterus will be thrown on the short lever 
forming the long curve in the posterior cul-de-sac. This causes 
the other end to rise and rest against the anterior wall of the va- 
gina near the neck of the bladder. In the horizontal position, the 
weight is removed, and the long lever rests in the axis of the va- 
gina. By thus adjusting itself, it cannot press so as to cut into 
the vaginal tissues. 

The pubis should be avoided as the chief point of support, if 
possible ; but this must be, when the anterior wall of the vagina 
is shortened by reason of an old retroversion, and where prolapse 
of the posterior wall occurs from perineal laceration. An opera- 
tion here becomes necessary. But for a temporary pessary, the 
only point of support is behind the symphysis. Under such cir- 
cumstances, the instrument must be wider below, and with the 
greater curve at this end, that downward pressure may crowd the 



128 DISEASES OF THE UTERUS AND ITS ANNEXES. 

other extremity up behind the pubes. Here a depression must be 
made to receive the neck of the bladder. The general laws for all 
pessaries are, that the instrument shall be small enough to admit 
the finger between it and the vaginal wall at any point while the 
patient is on her back ; it must be large enough to support the 
uterus, and yet allow the vagina to regain its normal size. To get 
the length for a pessary, the patient being on her back, pass a 
whalebone stick or any blunt instrument along the index finger 
into the posterior cul-de-sac, and measure from behind the pubes. 
Next, to get the proper curve. In retroversion, a longer curve is 
needed than when there is only a prolapse. Here the upper part 
of the vagina is more dilated than below, to which the instrument 
must conform, but not with so abrupt a curve as to press directly 
against the junction of the vagina, but beyond it, otherwise the 
circulation in the neck and womb is hindered, engorgement and 
erosion follow. 

Where there is thickening of the posterior wall and retroversion, 
the curve must be such that it will pass far beyond into the cul-de- 
sac. This extremity must be rounded gradually, and not be made 
too narrow for its length. In cases where the thickened edges of 
the ligaments are very sensitive, this must be removed by hot 
water injections, and the free application of iodine to the cul-de- 
sac every third or fourth day, and to take off the pressure, the 
recumbent position should be maintained. To allow of exercise, 
temporary support may be given by a cotton pessary, shaped like a 
large mushroom, and placed in front of the cervix. This is made by 
pressing a square pledget of damp cotton between the hands, and 
folding the corners towards the centre until a ball is formed of the 
proper size ; then holding the extremities between the fingers, a 
stem is made by wrapping cord between the ends and the ball 
portion. This, saturated with glycerine, will readily support a 
prolapse. 

When the cul-de-sac is absent or very small, a straight or flat 
pessary is used, fitted to receive support behind the symphysis, 
and put the vagina on the stretch so as to carry the uterine neck 
so far back as to make an anteversion. This must be watched lest 
it cut into the tissues. The shorter the vagina, the straighter 
must be the instrument, lest it rotate and remain across the axis 
of the canal. It must be wider in the middle than a curved one, 
in proportion to its length. 



DISPLACEMENTS. 129 

There is also a hollow rubber disk, which is useful in place of 
the cotton pessary where glycerine is not to be used. It is most 
useful where tenderness prevents the use of the ordinary form. 
To prevent pressure on the urethra or any tender point, a sulcus 
may be made by passing a small elastic band once or twice around 
its thickness. It may be placed in front or behind the uterus as 
occasion may demand. It prevents the sagging of the uterus in 
the pelvis. As rubber causes an offensive discharge by long 
retention, it is only temporary and should be removed at night, or 
when not needed, as in exercising. 

Sponge must never be used as a pessary. 

\\\ flexures of the uterus, ^his author says as soon as the true 
condition is appreciated, the intra-uterine stem will be abandoned, 
as also the practice of dilating with steel sounds or sponge tents. 
The use of either is faulty in theory, without permanent benefit,, 
and always dangerous. Where flexure is below the vaginal junc- 
tion, surgical aid may be useful. The proper time is shortly after 
the menstruation, and the incision should be made backward. Ini 
flexures of the body of the womb, hot water injections will give 
tone to the vessels. Iodine should be frequently applied to the- 
canal by the applicator bent to a curve corresponding to the flex- 
ure. When the uterus is enlarged, and the cervix hard, the acetic 
solution of cantharides should be applied to the neck after each. 
period, to produce a blister. This relieves the congestion, and acts 
revulsively and also produces uterine contractions. Glycerine on 
cotton must be used daily, and ergot with tonics given internally. 
It must be continued for a long time and not in doses to cause 
irritation of the stomach or marked uterine pains. When absorp- 
tion of tissue has left a permanent deformity, and there is no cel- 
lulitis, it is well to open the passage in order to prevent dysmen-- 
orrhoea. The posterior lip is to be divided backward, and a 
triangular portion raised and removed. Though occasionally 
successful, yet it often fails and there is a return to the old 
condition. 

Where procidentia exists, to such a degree that the pessary can 
not retain it, a surgical procedure becomes necessary. The object 
is to reduce the size of the vagina, which is accomplished, by tak- 
ing in a plait. 

In obstinate cases, this author anteverts the uterus with the 
finger as the patient lies on her back, the neck of the womb is- 
9 



I3O DISEASES OF THE UTERUS AND ITS ANNEXES. 

crowded into the posterior cul-de-sac by a sponge probang held 
by an assistant. He then seeks a point about half an inch to 
either side of the cervix and a little behind the line of the anterior 
lip, which two points can be drawn together in front of the uterus 
by a tenaculum in each hand. The surfaces are denuded and a 
similar surface in front of the uterus. A needle armed with a 
silk loop is passed beneath each freshened surface and they are 
brought together and held by a silver wire attached to the loop; 
the folded surface is denuded below and the joints united by 
sutures. 

THOMAS EDIS, M. D., OF THE MIDDLESEX HOSPITAL, LONDON. 

This writer observes that the genu-pectoral position proves of 
much service in all cases of retroversion and retroflexion, more 
especially when metritis also exists. In a short time patients be- 
come accustomed to the posture, and will say that they can get 
more relief in orte hour by resorting to this method than by lying 
down in the ordinary position for several consecutive hours. The 
uterus falls forward in the abdomen, pressure posteriorly being 
thus removed ; the distressing pain in the back, frequently com- 
plained of in these cases, disappears within a short time. In many 
instances, where a Hodge's pessary cannot be tolerated under 
ordinary circumstances, by resorting to this position for a quarter 
of an hour occasionally during the day, the instrument can be 
worn with comfort. The genu-pectoral position, also, offers 
manifest advantages in the replacement of the retroverted gravid 
uterus; also in pressing the uterus up beyond the pelvic brim in 
cases of impacted fibroids. In cases of prolapsus and subinvolu- 
tion, much may be gained by adopting this position. In the 
morning sickness of early pregnancy, and in cases of prolapse of 
the ovary, considerable relief may be thus obtained. 

DR. JOHN WILLIAMS, OF LONDON. 

Chronic inversion of the uterus frequently demands surgical in- 
terference for its relief. In some cases, however, success may be 
.achieved by the use of the repositor, or by elastic pressure. An 
instance of the successful employment of the latter is described 
by Dr. John Williams, of London (Obstet. Journal, April, 1879.) 
A.cup of vulcanite mounted on a metallic stem, having a peri- 
neal. curve was introduced. The cup was applied to the inveited 



DISPLACEMENTS. I 3 I 

fundus, and to the ring at the end of the stem were fastened four 
elastie bands, two of which were carried anteriorly between the 
thighs in front of the abdomen, and fastened by tapes to a broad 
strap of adhesive plaster placed round the waist, the other two 
elastic bands were carried posteriorly and fastened by similar 
means to the adhesive strap in such a manner as to cause the force 
exerted upon the fundus uteri to act, as far as could be judged, in 
the axis of the brim of the pelvis. There was some systemic and 
local reaction to the use of this apparatus, but after the first day 
no pain was complained of, and in two days the uterus reverted 
to its normal position and the cup was withdrawn. 

s 

PROF. MONTROSE A. PALLEN, M. D., OF NEW YORK. 

In cases where there is so much tenderness of the uterus and 
vagina, that an ordinary pessary cannot be worn, this gynecologist 
is in the habit of daily reducing the version by placing the woman 
in the genu-pectoral position, and lifting the perineum so that the 
vagina becomes ballooned and the uterus falls into the axis of the 
inlet, which is kept in position by introducing into the anterior 
and posterior arches of the vagina sufficient' thymolized clay* to 
fill the upper third of the canal; the lower two-thirds being 
padded with soft cotton. This makes a perfect pessary-support, 
retaining the uterus, bladder, and rectum in normal relationship. 
Prior to the next visit of the physician, the patient removes the 
cotton, and washes out the thymolized clay, when the same pro- 
cess is undergone again. It is remarkable how rapidly some 
patients yield to this process of treatment. In many instances in 
pregnant women, it is necessary to continue this method of pro- 
cedure until the uterus rises from the excavation, lest abortion 
ensue in consequence of jamming under the sacral promontory in 
retroversion, or cystitis develops because of the constant hyper- 
emia engendered by superincumbent uterine pressure. 

DR. J. R. KIRKPATRICK, OF DUBLIN. 

This writer [Dublin Journal of Medical Science, Feb. 1879), 
lays down the following : 

Rules for the use of Pessaries, the strict observance of which, 
he states, will tend much to the safety and comfort of patients, 

*See under Pruritus of the Vagina for the Formula. 



132 DISEASES OF THE UTERUS AND ITS ANNEXES. 

• and prove the surest safeguard in preventing all the accidents 
arising from the use of pessaries : 

1. In no case should a physician use a pessary without telling 
his patient that he has done so. 

2. That inasmuch as a pessary should give rise to no pain or 
uneasiness whatever, after its introduction, the patient should im- 
mediately come back, in the event of any such symptom occur- 
ring. 

3. She should return to have the instrument examined or re- 
moved, not later than six weeks or two months. 

4. That, in the event of any sensation of heat, pruritus, or 
irritation of the vagina, or the occurrence of any discharge, 
colored or otherwise, or any offensive smell, she should at once 
present herself to the doctor for examination. 

5. The daily use of a vaginal injection of tepid water, or of 
some mildly astringent wash, will have the most beneficial effect 
in arresting the first symptoms of vaginal irritation. If the pa- 
tient be wearing a Hodge pessary, she should be warned to use 
gentleness in introducing the pipe of the syringe, lest the instru- 
ment might be displaced. A patient need not be afraid of using 
an injection of simple warm water, even during the menstrual 
flow. This conduces very much to her comfort at the time, and 
the retention of any of the catamenial fluid is very apt to prove 
a source of irritation. 

6. If the vulva is much dilated from procidentia of the womb, it 
is well to keep the patient in the horizontal position for some days, 
whereby the womb will be kept up, and the vaginal orifice have, 
time to contract before the introduction of the pessary; for, 
although the introduction of a disc or globe pessary may be 
accomplished with great facility, its removal afterwards may be- 
come a matter of great difficulty, owing to the contraction of the 
vagina] orifice, consequent upon the womb being kept in situ, and 
no longer distending the parts. 

HOSPITALS OF PARIS, 

A local treatment of Prolapsus uteri has been recommended by 
some Parisian surgeons {La France Medicate \ July, 1879). The 
surgeon takes pure tannic acid and makes a concentrated solution 
of it in water, at the moment of using it. A score of little balls of 
charpie are made, and are allowed to soak thoroughly in the solu- 



DISPLACEMENTS. 133 

tion. A brush (camel's hair), with a long handle, is to be in 
readiness. The woman being in a suitable position, a speculum is 
introduced into the vagina which reduces the uterus, or the reduc- 
tion may be effected before its introduction. The brush is then 
dipped in the tannic acid solution, and being carried through the 
speculum, the uterine neck and the whole internal surface of the 
vagina is several times freely bathed, the speculum being with- 
drawn little by little, but re-introduced afterwards to pack the balls 
of charpie soaked in tannin in the uterine culs-de-sac, by means of 
a long pair of dressing forceps. The culs-de-sac are thus firmly 
packed, and the speculum being gradually withdrawn, the whole 
cavity of the vaginal canat is filled with these same balls, and the 
vulva is closed by a charpie tampon, which is externally supported 
by a compress. Complete rest in bed is observed, and twenty- 
four hours after its application the charpie is gently withdrawn, 
pellet by pellet. Cold vaginal injections, composed of a strong 
decoction of dried oak bark, are then prescribed, to be used three 
times a day. Before each of these injections the womb should be 
restored to position. At the end of two or three days at most, this 
operation is repeated, and so on, increasing little by little the in- 
tervals between the applications of the dressings ; and even after it 
is thought that a cure has been obtained, the injections alone 
should be continued for fifteen days or so. 

The proceeding is very simple, inexpensive, applicable at all 
times and in all places, necessitating neither special apparatus nor 
substances difficult to procure, nor traumatism ~of the genital 
organs; it is entirely painless, very easy of application, even for the 
most inexperienced physician, and secures at the end of some 
months an absolute and veritable cure of uterine prolapse. 

PROF. ELLERSLIE WALLACE, M. D., PHILADELPHIA, 

Employs a curved sponge-tent, reinforced by a steel spring. The 
spring is introduced within the interior of the tent, and by its 
tendency to resume its original form after being bent in the 
reverse direction, acts to lift up the bent womb. The theory is not 
that of effacing the curve by dilatation, but the principle is that by 
the erection of the tent, by virtue of its elasticity, the curve of the 
uterus is effaced by the gentle, yet powerful, action of the tent as a 
lifting force, which elevates the fundus of the uterus from its ab- 
normal position. The first tent should be of small size and with- 



134 DISEASES OF THE UTERUS AND ITS ANNEXES. 

out a spring, because the bulk of the sponge would not be 
sufficient to hold the spring to its proper curve. In making these 
tents, the sponge should be elastic and moderately close-grained. 
A cylinder, free from large cavities, is to be cut from it, corres- 
ponding in length to the uterine cavity, and having in its long axis 
a gentle curve, similar to the natural bend in the womb. This 
cylinder is to be a little thicker than the thumb, but may vary in 
proportion to the effect desired. Wash it well, and trim it 
smoothly. Next, make an opening in the centre from one end 
almost to the other, and pass into this a piece of watch-spring x / 2 
an inch shorter than the tent, and with an eye at each extremity. 
The spring is fastened by a silk thread passed through the sponge 
and the eye, around the cylinder and again through the eye, and 
tied tightly. The other end of the tent and the eye are transfixed 
by a stout needle. The tent is then soaked in a thick solution of 
gum-acacia, then wrapped closely with strong twine from one end 
to the other. It may now be moulded into any desired curves. 
A sound bent to the shape of the uterine cavity is laid on a piece 
of wood, and its course marked by tacks. The moist tent is then 
put into the place of the sound, and allowed to dry there. The 
needle indicates the position of the spring: 

The hard dry tent is removed and the twine unwound. It must 
now be smoothed by fine sand-paper and the end bevelled, but not 
to a point. Rub it with wax and burnish it with any hard instru- 
ment. It is completed by passing a string through the opening 
occupied by the needle. This is for convenience of extraction, and 
also aids in securing the spring in the centre of the tent. As a 
rule, three curves will be all that will be required. Those most 
used are a moderate curve, only a little more than the natural 
uterine bend ; a fish-hook curve for extreme cases; and an inter- 
mediate one, which will probably be most required. 

ALBERT H. SMITH, M. D., PHILADELPHIA, 

Has materially and usefully modified the lever pessary of Prof. 
Hodge. He lengthens the closed lever so that its length is about 
twice its width ; he makes it ovoidal, with the apex in front, curves 
the anterior bar from above downward, and curves the posterior 
bar upward. He claims that it is easily retained in place, its length 
and ovoidal form adapting it to the shape of the vagina, which is 
conoidal, with its base toward the vaginal cul-de-sac, while on the 



DISPLACEMENTS. 135 

contrary the rectangular pessary cannot be accommodated and re- 
tained ; the curvature of the posterior bar takes away the sharp 
angles behind, and the centre of the bar resting directly behind 
the lower portion of the body of the uterus, allows it to hang over 
it, suspended by its vaginal attachment, without undue pressure 
upon the vaginal tissues, as from the straight bar the depression of 
the anterior bar rounds off the corners which rest against the 
vagina, and relieves the urethra from pressure. 

Dr. S. claims as the merits of the lever pessary its ease of intro- 
duction ; its deriving its support from the floor of the pelvis, mak- 
ing no tension of the vagina, acting as a true lever, its fulcrum being 
the pelvic floor, the weight — the uterus — resting upon the short 
arm, and the power acting on the long arm, being the elasticity of 
the anterior vaginal wall, the weight of the intestines, and the ac- 
tion of the abdominal muscles ; these two latter forces, which would 
operate upon the uterus to keep it displaced, being utilized to ele- 
vate it; preserving the natural mobility of the uterus ; making no 
pressure on the neck, acting so as not to interfere with the func- 
tions of reproduction. 

Perhaps not the least useful relief is that noticed by pregnant 
females when wearing this pessary, the absence of extreme nausea. 
Dr. Smith believes this point is one calling for clinical study. 

EUGENE C. GEHRUNG, M. D., ST. LOUIS, 

Has invented a pessary which strongly resembles a Hodge closed 
pessary folded on itself. The two arches thus formed rest against 
the anterior wall of the vagina ; the lower one resting near or 
upon the os pubis, according to the degree of tonicity of the 
vagina, from which point it derives its anterior support. The 
lower branches of the lateral curves rest on each side of the 
vaginal aperture in an antero-posterior direction on the vaginal 
surface of the perineum. These prevent the instrument from ro- 
tating on the transverse and antero-posterior axis. An additional 
support is gained by the contact with the elastic vaginal walls and 
their close coaptation to and insinuation between the arches and 
curves of the pessary. It rests within the vaginal grasp as a seg- 
ment of a solid cylinder would rest in the grasp of an elastic one. 
Hence there is no obstruction of the vaginal space. The distance 
between the two arches varies from i 1 /^ to \yi inches. The 



I36 DISEASES OF THE UTERUS AND ITS ANNEXES. 

antero- posterior and transverse diameters vary as the size of the 
instrument. 

The pessary is introduced with the patient on her back, the 
knees well flexed and separated ; and the curves so placed that 
the instrument shall rest in the position at first described. 

Dr. Gehrung claims that few cases of anteve'rsion can resist its 
action, when well-fitted, unless firm adhesions confine the womb 
to the unnatural position. It has no fixed points of resistance, is 
supported everywhere, and allows free motion to the womb. It is 
simple in construction. It is inelastic, and hence its operation is 
under perfect control. Its material is such that it can readily be 
modified to suit. It does not interfere with marital relations. It 
is easily introduced and removed, and it causes no obstruction to 
the rectum, or bladder, or pressure anywhere. 

The anteflexion pessary is the same pessary with the addition of 
a slightly excavated and inclined blade or shield. It supports the 
body of the womb, and compels the neck to retain its proper po- 
sition, and thus straightens it. 

For retroversion and later o-version the pessary is the Hodge pes- 
sary, with the addition of an arched blade or shield connecting 
the two lateral branches into a solid body for the distance of 1 ^ 
inches. It acts by replacing the body and preventing the neck 
from following its motion to an abnormal position. 

Dr. G. calls this form the retroflexion pessary, and sums up as 
follows : " This pessary combines the several qualities of a retro- 
version, retrolatero-version, retroflexion, and retrolatero-flexion 
pessary, and in addition the quality of protecting, especially the 
rectum from cervical compression, and the womb from bein 
thrown into complete anteversio.ru" 



NON-MALIGNANT GROWTHS. 

T. GAILLARD THOMAS, M. D., NEW YORK. 

Polypi. The treatment is palliative or curative. The first is 
necessary where the conditions are unfavorable to the immediate 
attempt at a radical cure. If practicable, manipulation should be 
delayed until the tumor is expelled into the vagina. Use palliative 
treatment to replace the womb if displaced and maintain it by a 
proper support, removing all pressure from above; keep the pa- 
tient in bed at her periods, giving only cold and acid drinks, and 
administering cannabis indica, opium, gallic acid, ergot, or aromatic 
sulphuric acid. After the epoch has lasted four days, apply a 
tampon with solution of alum or tannin: keep the bowels regular 
and avoid fatigue; give nutritious food, bitter tonics, and nervines 
as they maybe indicated, but avoid the use of iron which increases 
the hemorrhagic tendency. At bed-time, during the interval, 
syringe the vagina with tepid water, and insert a suppository of 
tannin high up. 

The curative treatment will be to remove or destroy the tumor. 
If the canal has been dilated by the polypus, the walls may be slit 
on each side nearly to the vaginal junction, and the tumor drawn 
out by a tenaculum. Or complete dilatation may be secured by 
means of tents, and the tumor may be aided in its exit by the use 
of ergot. If it become necessary to seek the pedicle near the 
fundus, it may be severed by excisipn, torsion, ligature, ecrase- 
ment, the galvano-caustic wire. If within reach of the knife or 
scissors, it may be divided. When higher up, Simpson's polyp- 
tome comes into use. Small growths may be scraped off by the 
curette, or twisted off with the forceps. The ligature is objection- 
able, ecrasement is better. For this, Hicks' wire rope ecraseur is 
excellent. A hard, fibrous polypus, too large for its pedicle to be 
reached, may be cut away piecemeal by a curved scissors or Nela- 
ton's forceps ; or destroyed by deep incisions into its mass. When 
possible to encircle the pedicle with the galvano-caustic wire, this 
instrument is preferable. It cuts without force, and there is no 
hemorrhage. 

(^37) 



I38 DISEASES OF THE UTERUS AND ITS ANNEXES. 

LOMBE ATTHILL, M. D., DUBLIN. 

Mucous polypi are best removed by the wire loop twisted, or by 
the ecraseur. In all cases, the seat of origin must be cauterized 
with nitric acid. He passes the wire, in cases where the mass is 
attached to the fundus, by means of two slender silver tubes like 
those known as " Gooch's canulae." When these reach the base 
of the tumor, they are separated and one is passed around, carry- 
ing with it the wire. The canulae are then passed through open- 
ings in the extremity of the ecraseur, the wires attached, and drawn 
tight until the tumor is cut off. 

PROF. ROBERT BARNES, M. D., LONDON, 

and other authors, agree as to the abandonment of the slow method 
of strangulation, for fear of pyemia, and the substitution of the 
quick operation by the Ecraseur, when possible. The galvanic 
cautery appears to be a favorite with all. 

THOMAS ADDIS EMMET, M. D., NEW YORK, 

has invented an ecraseur for the removal of these growths. He 
preferred a chain to the wire, and finding that this would break, 
and as the curved ecraseur did not always prevent this, he placed 
three joints at the end, so that it could be opened straight, or bent 
upon itself at a sharp angle. To facilitate the application of the 
chain, the ends were attached to two flat rods or bands, which 
could then be passed between the two halves of the ratchet por- 
tion, and secured at the handle by a spring catch. To aid in plac- 
ing the chain close up around the base of the tumor, when 
situated high up, as at the^ fundus, he employs a copper sound, 
with a small circular eye at its end, or a flat piece of whalebone 
carefully rounded and smoothed with an opening at the end. 
Through the eye or opening, a strand is passed with a loop, in 
which is included the chain. By this instrument, the chain is 
very readily carried up close around the point from which the 
mass springs. 

This author regards the curved scissors as equally applicable 
where they can be employed for the removal of these growths. 
He also uses what he calls his "enucleator," a curved steel plate 
with a saw edge placed over the end of the index finger, and held 
in place by a band. With this he separates the tissues when the 



NON-MALIGNANT GROWTHS. * I 39 

other means cannot be employed. A rule to be observed is, that 
when the pedicle is of small diameter, it may be cut close to the 
uterus; but if short and broad, the separation should be made near 
the tumor, lest a partial inversion or indentation be caused. 

Where fibrous tumors are not pedunculated, he excites uterine 
contraction by traction on the growth toward the os uteri. This 
causes pedunculation by the crowding out of the tumor from its 
bed by muscular contraction behind. He prefers a cord with a 
slip-knot placed around the growth with which to make traction. 
It is of no importance as to the thinness of the uterine walls, as 
the contraction will close up the space as fast as the tumor is with- 
drawn. It is safer than enucleation, as it can not be known how 
far the uterine tissue is involved. As a principle of practice, he 
would delay surgical interference as long as possible ; but when 
the tumor presents at the os, the operation should be considered, 
for its appearance in the vagina will lead at once to the question 
of blood poisoning. The operation once begun, it must be com- 
pleted, as entailing least risk. The purpose is to excite uterine 
contraction, and this will be continued by traction on the tumor as 
it is removed piecemeal. The best means for removal is a pair of 
blunt-pointed scissors, curved on the flat. The ecraseur is not 
fitted for it, as it does not excite the contractions, nor is the mass 
so rapidly removed. After having removed the portion which 
first filled the vagina, follow as far as possible the uterine canal. 
The after treatment will be to wash out the cavity thoroughly with 
hot water, and then apply freely Churchill's strong tincture of 
iodine. This arrests the oozing, and is a valuable antiseptic. 
Never introduce the subsulphate of iron into the cavity, as it is not 
astringent, and only fills it with coagulated blood, to decompose 
and cause blood poisoning. After the iodine, a little cotton satu- 
rated with glycerine may be packed in, and we may even fill the 
cavity with cotton damped with a strong solution of alum. Re- 
move this on the second day, and if bleeding has ceased, omit all 
dressings, and merely wash freely with warm water, and if there is 
decomposition, add a little brewer's yeast or carbolic acid. 

Fibrous growths are to be rempved when it can be done with a 
reasonable degree of safety, or their development arrested and the 
patient's strength preserved by checking the loss of blood. A 
cardinal rule is not to destroy the vitality of the tumor in situ, lest 
we add the risk of blood-poisoning. Hence, the action of hot 



I40 DISEASES OF THE UTERUS AND ITS ANNEXES. 

water injections, iodine, and ergot, will be beneficial. The latter 
must be used only in small and repeated doses, to excite moderate 
contraction. It is only to be used in large doses when the os is 
dilated and it is believed that the tumor is ready for removal. 
The watery extract of ergot, in the proportion of three parts to 
about seven of water and the same quantity of glycerine, may be 
used subcutaneously. 

Dr. Ephraim Cutter, of Boston, proposes a carefully regulated 
diet, chiefly of*animal food, and in a number of cases there was 
observed a marked decrease in the tumors. 

The general treatment should be to improve the health. The 
patient should be in a recumbent position during menstruation, but 
at other times she should be as much as possible in the open air. 
Iron seems to increase the hemorrhage, but the action of sunlight 
on the skin will tend to obviate this. Constipation must be 
avoided. Food should be in the concentrated form, leaving little 
for excrement or to cause flatus. Inspissated ox-gall will aid in 
relieving constipation. As the tumor increases, it should be gotten 
out of the pelvis, lest it cause disturbance by pressure. Displace- 
ments are to be relieved by mechanical support. 

To control the hemorrhage, position is very important; even 
keeping the pelvis above the level to check the flow toward the 
organs. Ergot cannot be relied on ; it rather increases the flow, 
and should only be used in the intervals as above. Opium allays 
local irritation, quiets the circulation, and secures contraction of 
the capillaries. It is best given by the rectum. Gallic acid and 
cinnamon may be given, a drachm of the former rubbed up in an 
ounce of simple syrup; then add four ounces of cinnamon water 
and three of pure water; dose, a tablespoonful every 2 or 3 
hours. If this cause nausea, dilute it more, diminish the dose, and 
lengthen the interval. Drs. Churchill and McGlintock highly 
recommend tincture of cannabis indica in ten-drop doses three 
times a day. McClintock gives T ^- grain of bichloride of mercury 
every 6 hours. The only reliable means are local applications : 
hot water injections, tincture of iodine, dilatation of the canal if 
necessary, and, above all, a tampon of cotton saturated with solu- 
tion of alum, or one of oakum. By means of the applicator, a 
tuft of cotton, loaded with' Churchill's tincture of iodine may be 
applied to the fundus, and allowed to remain until forced out. By 
means of a projecting end, it may be removed if required. The 



NON-MALIGNANT GROWTHS. I4I 

iodine may be injected by a hard rubber syringe, with the end 
properly curved. The nozzle is to be carried up to the fundus like 
a probe, and the iodine forced out very slowly, the patient lying on 
her left side, with a sponge at the os to prevent the escape to the 
vaginal walls, which it would greatly irritate. When the strength 
is not too much exhausted, she should be placed on her knees and 
elbows, with the os exposed by the speculum during the injection. 
This generally promptly arrests the hemorrhage. The amount 
injected should not exceed a drachm. In the absence of the long- 
nozzled syringe, a flexible catheter may be carefully passed up, and 
the injection thrown in by means of a glass syringe. To increase 
the action of the iodine, hok water irrigation should be used. A 
rubber bag may be introduced on the point of the sound, and then 
filled with water, thus making direct pressure on the bleeding sur- 
face. 

Surgical measures are the division of the cervix and the destruc- 
tion of the tumor. Velpeau, Amussat and Sims enucleate or 
tear these tumors from their beds. The late Dr. Atlee took out 
a section, and thus destroyed the vitality. Simpson introduced 
caustic within the mass. 

G. DE GORREQUER GRIFFITH, L. R. C. P., LONDON, 

Puts the patient to bed and keeps her there, thus securing quiet in 
every way (Obst. your., G. B. & I., March, 1878); cleanses the 
bowels, and two days after dilates the os and cervix with a sea- 
tangle tent to a point short of occasioning much pain. Behind 
the tent, he inserts a tampon of cotton-wool soaked in iodine and 
glycerine, or glycerine and Condy's fluid. At the end of two 
days, a great watery discharge issues from the vagina; the tampon 
may be slightly tainted ; the os will be spongy and soft. The 
vagina must be well washed with a disinfectant. At the end of a 
second day, a larger tent is used, and so repeated till the os and 
cervix admit two fingers. Thus he disperses small intra-mural 
fibroids, situated in the lips of the os, in the cervix, or even at the 
fundus, and malposition is often corrected. Intractable cases re- 
quire more dilatation, and often painting the os and cervix with the 
acid nitrate of mercury; or in slow cases, he packs the interior of 
the uterus with pellets of cotton-wool soaked as above. This he 
repeats till the cure is effected, say every two days. Larger 
tumors require that the liquid mercury be swept lightly around 



142 DISEASES OF THE UTERUS AND ITS ANNEXES. 

the cavity by means of a wire and a packing of wool as above. 
At the next sitting the mercury is more freely used, being well 
tolerated ; and finally he introduces a pellet squeezed out of the 
mercury, held in place by the tampon and left for two days, using 
at the same time, by the rectum, morphia suppositories. During 
this time, he gives ergot and strychnia, as they act on the enlarged 
and dilated womb and aid the dispersion. He even uses this plan 
where growths involve the womb itself intimately; the shorter the 
pedicle, the more hopeful the case. 

Never pack the womb too full of the pellets, lest the pain they 
cause require their removal. 

Latterly, he uses in place of the mercury, purified carbolic acid 
in crystals, or a saturated solution by the pellets, and packs the 
cavity below, the os, and even the upper portion of the vagina, 
with wadding steeped in glycerine. The carbolic acid allays the 
pain excited by the mercury, if they are used together. The acid 
causes the living tissue to blanche, dry and shrivel. 

The flow of serum from the vagina is remarkable, and may be 
taken for hemorrhage or even for an escape of urine. It is re- 
markable how rapidly fibromatous conditions were removed by the 
mere use of the dilating tents, with the ergot and strychnia. He 
explains this, that the tent has effected dilatation, expanded the os 
and cervix, thus causing direct pressure from within ; the fibres of 
the womb contract, and these two antagonistic forces diminish the 
blood supply, diminish the growth, and it is speedily obliterated. 
Of course, the acids, when used, act directly as destructive agents. 

THE MEDICAL TREATMENT OF UTERINE TUMORS. 

Fibroid Tumors. From numerous sources, lately, the assertion 
has been made that interstitial fibroid tumor of the uterus can be 
treated hypodermically by the aqueous solution of ergot, with emi- 
nently more satisfactory results than by any other mode of treat- 
ment, or by operation. 

146. I£. Ergotinse (Bonjean's), 5j 

Glycerinae, f.5j 

Aquae destillatae, f.fj. M. 

Inject twelve drops daily, hypodermically. 

Dr. Byford prefers Squibb's fluid extract to any other form of 
ergot ; and Dr. Atthill recommends the omission of the glycer- 



NON-MALIGNANT GROWTHS. H3 

ine, and prefers a solution of one part of the extractum ergotae 
liquidum {British Pharmacopoeia) in two of water, injecting 15 or 
20 minims of this each time. He always inserts the needle into 
the gluteus muscle, making it penetrate to the depth of more than 
an inch. 

Dr. J. W. Walker, of Indiana, has reported success from the 
use of the ergot of maize, the ustilago viaidis (New Prepar., Jan., 

Dr. Bvford adds some further direction on the ergot treatment 
in a recent article (Chicago Medical Journal and Examiner, Oct., 
1879). The .mode of administration should be governed by the 
objects to be attained. If we desire to cause the painless absorp- 
tion of the tumor, the doses ought to be moderate in size, and not 
too frequently administered. Hildebrandt administered by hypo- 
dermic injection a preparation in quantities which represented 
from fifteen to twenty grains of the crude drug once daily, or 
once every other day ; and it will often be sufficient once a week. 
If we desire to have the tumor expelled, we should administer full 
and increasing doses, often repeated, and continued until the ob- 
ject is attained. 

It will sometimes be necessary to vary the quantity and times of 
giving it, to suit the susceptibility of the patient ; less or more ac- 
cording to the amount of pain caused by it. 

It is not essential to give it hypodermically, although when it 
does not produce much inconvenience, this is a very efficacious 
method ; it may be given by the mouth, in suppositories, per rec- 
tum, etc. 

When we administer ergot for the cure of fibrous tumors of the 
uterus, the beneficial action of the drug will depend upon the 
degree of development of the fibres of the uterus, and the position 
of the tumor with reference to the serous or mucous surface. 
The nearer the mucous surface, the better the effects. If the 
tumor is very near the lining membrane, we may hope for its ex- 
pulsion en masse, or by disintegration. 

We can often select the cases in which good results may be ex- 
pected. There are four conditions which are usually reliable for 
this purpose. They are, smoothness of contour, hemorrhage, 
lengthened uterine cavity, and elasticity. A smooth, round 
tumor denotes, for the most part, uniform textural development; 
hemorrhage, a certain proximity to the mucous membrane; a 



144 DISEASES OF THE UTERUS AND ITS ANNEXES. 

lengthened cavity, great increase in the length and strength of the 
fibres; and elasticity assures us of the fact that cartilaginoid or 
calcareous degeneration has not begun in the tumor. 

An even nodulated tumor may be composed of many separate 
solid masses. These displace and prevent the growth of the fibres 
to such an extent as to render contractions inefficient. When 
hemorrhage is not present, the tumor is probably near the serous 
surface, and consequently not surrounded by fibres. 

Uterine Polypi. The chloride of calcium, once popular as a 
remedy for goitre, has recently been advocated by various Irish 
physicians as efficient in bringing about the expulsion of uterine 
polypi [Irish Hospital Gazette, September 15th, 1874). The for- 
mula is : 

147. I£. Liquoris calcii chloridi, f.3iv 

Tincturae ferri chloridi, 

Spiritus chloroformi, aa f.5j 
Tincturae aurantii, f.3ij 

Infusi calumbse, f . § v i j . M. 

Two tablespoonfuls three times a day. 

These polypi can, also, in many instances, be expelled by the 
administration of ergot, either by the mouth or subcutaneously. 
In the hemorrhage which accompanies these growths, perhaps the 
best injection is of solution of subsulphate of iron, as follows : 

148. I£. Liquoris ferri subsulphatis, f.^ss 

Aquae, f.^ij. M. 

To be used for intra-uterine injections. 

This strength cannot be exceeded with safety, and frequently 
one-half the amount of the salt will be sufficient. 

Prof. Jones, of the Medical College of Georgia, and other 
Southern physicians, have claimed that the free administration of 
muriate of ammonia brings about the discussion of fibroid tumors 
of the womb, hypertrophic contractions of the uterine walls, and 
allied troubles. It may be alternated with ergot. 

In coxcomb granulations of the os, the best application is strong 
cider vinegar, or crude acetic acid. It may be poured into a spec- 
ulum and allowed to cover the diseased portion for about five 
minutes. This should be repeated every other day. Nitrate of 
silver is liable to excite hemorrhage if applied to this form of 
erosion. 



NON-MALIGNANT GROWTHS. 145 

In simple ulcerations of the os much good often follows the use 
of io do- tannin : 

149. $. Iodinii, 5j 

Acidi tannici, f-lj 

Aquae, Oj. M. 

Filter and evaporate to giv. To be applied to the ulcerated surface 

Or, for extemporaneous use : 

150. I£. Tincturae iodinii, 

Tincturae gallae, aa f.gss. M. 

For local use. 

J. T. Everett, M. D. {American Journal of Obstetrics, January, 
1878), concludes, from his notes of cases, that: 

1st. A judicious use of the faradic current is as certain and 
powerful to produce uterine contractions as ergot. 

2d. It is more easily controlled. 

3d. It does not disturb nutrition, or any of the secretions, nor 
does it interfere with digestion. 

4th. It does not induce pain in distant organs, and is not fol- 
lowed by cephalic disturbance or nervous shock. 

5th. It does not give rise to inflammations, or produce other 
local injuries. 

Dr. Robert Bell, London, reports in the Lancet, Feb., 1879, 
several cases successfully treated with ergotine suppositories. 
These contained each 4 grains, and were inserted each night, re- 
sulting in the expulsion of the tumor. 

F. A. GALLOIS, M. D., PARIS. 

151. I£. Morphias muriatis, 5j-ij 

Sacchari, gr.iv 

Cerae albae, 5j 

Butyri cacao, §ss. 

Melt over a slow fire the cocoa butter and the wax, incorporate the 
sugar and morphia, carefully triturated together, and when the 
mixture is on the point of forming a mass, run it into four horns of 
paper, and allow it to cool. 

These vaginal suppositories are useful in painful affections of the 
uterus, rectum, and bladder. 

RESUME OF REMEDIES. 

Ammonii Miirias. Both Drs. W. L. Atlee and E. R. Peaslee have 
witnessed disappearance of uterine polypoids from the long 
continued administration of this agent, gr. x, thrice daily. It 
is best given in the form of compressed pills. 
10 



I46 DISEASES OF THE UTERUS AND ITS ANNEXES. 

Calcii Chloridwn. This was recommended by Dr. McClintock (See 
F. 147). Dr. Tilt gives gr. x twice daily. He remarks that 
its effects are more positive after the change of life,. and adds 
the caution that its long continued exhibition has been known 
to cause arcus senilis and other evidences of arterial degenera- 
tion. 

Cannabis Indica and 

Digitalis as anemiants of the reproductive organs have some claims to 
consideration as checking the development of new growths. 

Ergota. The exhibition of this maybe either (1) by the mouth; (2) 
by the hypodermic injection ; (3) by suppositories. (See 
pp. 139). When given by the mouth, Goodell believes its per- 
manent effect is enhanced by combination with iodide of 
potassium. The os should be dilated at the same time. Pro 
fessor Hildebrandt proposed daily hypodermic injections of 
the aqueous extract under the skin around the umbilicus. He 
uses : 

1 52. ^. Ergotinae, 6 parts 

Glycerinse, 

Aquae, aa 15 parts. M. 

Successful cases have been reported in Philadelphia by this 
means, one by Dr. W. V. Keating, who uses : 

153. ^. Ergotinae, . gr.xlv 

Glycerinse, 

Aquae destillatae, aa "Kiev. M. 

Prof. John Ashurst, Jr., employs : 

154. fy. Ext. ergotae fluidae, f.Siss 

Glycerinae, f.5j 

Aquae, f.3ij. M. 

Of either of these ""l. xx. is a sufficient injection : the nozzle 

of the syringe should be carried down to the muscular walls of 

the abdomen in order to avoid the formation of abscesses. 

Rectal and vaginal suppositories of about gr. x. each of the 

solid extract are used by some. 

Ferrum in various forms may be advantageously used to combat the 
anemia. Goodell combines it with ergot. 

Gallicum Acidum stands next to ergot as a hemostatic in polypoid hem- 
orrhages (Goodell). 

Hydrargyri Biniodidum. Goodell records the marked diminution of a 
very large fibroid after long continued frictions with an oint- 
ment composed of gr. viij. of the mercuric biniodide to 
lard §ss. 

Hydrargyri Chloridum Corrosivwn. Drs. T. M. Madden and Routh, 
of London, report cases where this agent appears to have di- 
minished uterine polypoid growths in a marked degree (Half 
Yearly Compendium, July, 1874). 



NON-MALIGNANT GROWTHS. 147 

Iodinium In the medical treatment of uterine polypi, Dr. T. M. Mad 
den states that be has found the long continued use of small 
doses of tincture of iodine serviceable. 

Potassii Bromidum is spoken of with decided favor by Simpson and 
Galabin, but doubtfully by Goodell. It should be continued 
for months in moderately full doses. 

Potassii Iodidum has a certain amount of testimony in its favor, for re- 
ducing uterine polypoids. Goodell combines it with ergot. 

Sulphuricum Acidum. In the bleeding from uterine fibroids, Goodell 
recommends : 

155. ^. Ouiniae sulphatis, gr.ij 

Acidi sulphurici aromatici, gtt.xx 

Aquae, s q. s. M. 

For one dose every two hours. 

Ustilago Maidis, the ergot of maize, is said to act similarly to that of 

rye. 
Vinca Major is praised by Mr. Spencer Wells, as an efficient agent to 

combat the anemia and debility following hemorrhagic tumors. 

An infusion of gij. of the leaves to f.^xx. of boiling water, f.^ij 

every 3 or 4 hours : or f.3j of the fluid extract, are the proper 

doses. 

OTHER MEASURES. 

Baths, containing bromine and iodine, taken in connection with the 
internal administration of these agents, are commended by 
Galabin. 

Electrolysis has been highly lauded by some authorities (p. 141). Its 
claims are not yet made out. 

Galvanism. The constant galvanic current has caused in some instances 
retrogressive changes in fibroid uterine tumors. Goodell 
speaks of it as an agent from which in the future much may be 
expected. 

Leeches. Dr. Tilt observes that even bad cases of uterine fibroids may 
be greatly improved by hygiene, by saline purgatives, and by 
the application to the cervix of two or three leeches, just before 
menstruation. 

Mineral Waters, especially those of Kreuznach and Woodhall Spa, con- 
taining bromine or iodine, are believed to be valuable. Prof. 
A. R. Simpson says : "I have seen patients who were suffering 
from such tumors in whom the symptoms were relieved, and in 
whom the growth of a previously increasing tumor was arrested, 
if the bulk was not immediately diminished. These mineral 
waters seem to me to exert some portion of their influence by 
acting as sedatives to the sexual organs, lessening the activity of 
the circulation in them, and so reducing the nutritional activity." 

Pressure, by a firm, broad, elastic bandage retained by a perineal strap, 
will give great relief in some cases. 



MALIGNANT GROWTHS. 

PROF. E. J. TILT, M. D., LONDON, 

In flooding from cancer, scrapes away from the cervix the outlying 
portion of diseased tissue, and applies the liq. ferri sub-sulph., or 
the fuming nitric acid. There is no cure. A fair trial should be 
given to the solution of iodide of arsenic and mercury, each drachm 
containing ^ grain protoxide of arsenic, and \ grain of protiodide of 
mercury. Dose, half a drachm twice a day. It may cause marked 
improvement. Atlee had great faith in arsenic, in small doses 
for a long time, and locally a weak solution of iodine in glycerine. 
A drachm each of iodine and of iodide of potassium are dissolved 
in two drachms of glycerine, and applied by a brush, or on cot- 
ton, two or three times a week all over the cervix and to any part 
of the growth within reach. To relieve the pain, sedatives and 
anaesthetics. Ice to the neck of the womb is a palliative, also pro- 
longed irrigation with cold water. To destroy the odor, the chlor- 
inated lime, one ounce to the pint of fluid, with a drachm of 
laudanum, and a tablespoonful of glycerine to prevent irritation. 
A weak solution of carbolic acid is a good disinfectant. A good 
hemostatic is a strong solution of liq. ferri sub-sulph. thrown in 
with a sponge, allowed to remain in contact with the cancer, and 
then sucked up, and some cotton wool saturated with a styptic left 
in contact with the sore, to be removed in a few hours. Repeat 
once a week. It does good in the worst cases, and may effect a 
cure in mild forms. If no other operation is admitted, remove 
by scraping all the softened tissue that can be done without caus- 
ing too much pain or bleeding. 

WYNNE WILLIAMS, M. D., LONDON, 

Applies to the denuded surface, and also injects, a solution of 
twelve grains of bromine in a drachm of alcohol. Routh dresses 
the raw surface with gastric juice. It is best to remove the 
diseased tissues early with the knife. 

PROF. GRAILY HEWITT, M. D., LONDON. 

This author regards amputation of the cervix in cancroid of the 
os as valuable. It arrests bleeding and exhaustive discharges 

(148) 



• MALIGNANT GROWTHS. 149 

He prefers the ecraseur, or the scissors. He then applies per- 
chloride of iron in glycerine on lint to the cut surface, and plugs 
the vagina with wetted wool. Hemorrhage is to be checked by 
ice water injections into the vagina and rectum, perchloride of 
iron or tannin, the actual cautery, and plugging the vagina. Sir 
1. V. Simpson extols the use of a saturated solution of perchloride 
of iron in glycerine by means of a sponge to the surface. Tannin 
in fine powder, or tannic acid, may be applied through a tube or in 
form of a pessary. Cauliflower excrescences may be broken off, 
and tincture of iron injected into the mass. 

Dr. Hicks found a saturated solution of alum, holding in sus- 
pense tannic acid, applied daily, very effectual. A sponge dipped 
in strong solution of nitrate of silver is equally valuable. To re- 
move the offensive discharges, wash out frequently with solutions 
of disinfectants. For the pain, use opium, etc. It is found most 
effectual in the form of a lavement. The application of carbonic 
acid gas to the surface of the sore has been suggested. An ordin- 
ary quart bottle is used, with an elastic tube fitted to the cork. 
Eight drachms of carbonate of soda, and six of tartaric acid, are 
dissolved in water in the bottle, and the gas is generated. The 
vapor of chloroform may be mixed with it. Nutrition is import- 
ant ; milk is a valuable article of diet. The urinary organs often 
require relief. For irritability of the bladder, Vichy water, uva 
ursi, or pareira, with a little liquor potassae are useful. Sir H. 
Thompson suggests triticum repens. 

LOMBE ATTHILL, M. D., DUBLIN, 

To lesson fetor, add half an ounce of permanganate of potassa 
to a pint of tepid water, and inject twice a day ; or a weak solution 
of carbolic acid, as an ounce dissolved in eight ounces of water, a 
tablespoonful of this to be added to half a pint of tepid water; or 
nitrate of silver, 10 grs. to the ounce, of which 2 or three ounces 
should be used each time. Internally, iron and arsenic ; prefera- 
bly the tincture of perchloride of iron, or if the stomach is irrita- 
ble, the ammonio-citrate. In cauliflower excresence, amputate the 
cervix, or destroy the growth by repeated applications of caustic 
potassa. 

T. GAILLARD THOMAS, M. D., NEW YORK, 

Has never seen any benefit from the use of caustics in true 
cancer. He checks hemorrhage by the styptics already mentioned, 



I50 DISEASES OF THE UTERUS AND ITS ANNEXES. 

but prefers for this purpose the careful use of caustics so as to 
produce only a superficial slough, and thus temporarily seal the 
vessels. Every two or three weeks, after cleansing with cold 
water, touch the surface lightly by the actual cautery, acid nitrate 
of mercury, or pure nitric acid. Relieve pain by opiates, and in 
many cases chloral will be found an excellent substitute or alter- 
nate for opium. Correct fetor by the usual lotions of carbolic 
acid, one to two drachms to the pint, or the same proportion of liq. 
sodae chlorinatae, or one drachm of powdered subsulphate of iron 
to the pint, or a weak solution of iodide of lead. Keep up strength 
by use of milk, beef-tea, etc. Use iron freely to repair damages, 
and quinine as a tonic roborant and an excellent remedy for the 
neuralgic pains. 

In epithelial cancer, the disease maybe checked, if not cured, by 
the entire removal of the diseased portion. If amputation be not 
advisable, cauterization should be performed so deeply as to de- 
stroy the surfaces by means of the cautery, potassa cum calce, or 
the acid nitrate of mercury. This will at least relieve pain, arrest 
hemorrhage, and restrain the discharges. He applies the potassa 
cum calce in the proportion of two parts of lime to one of caustic 
potassa. 

THOMAS ADDIS EMMET, M. D., NEW YORK. 

This author in cancer of the uterus urges to operate without 
delay. When limited to the cervix, the scissors or knife is best 
with which to amputate, and by all means, if it can be done, get 
into healthy tissue. Healing the cut surface by granulation is lia- 
ble to act adversely, by causing a renewal of the disease. It is 
better to cover the stump by sliding the vaginal tissue over it, and 
secure the edges of the flaps with sutures. Where the disease has 
advanced too far for amputation, the actual cautery must be used. 
All the diseased tissue is to be scraped away down to a healthy 
surface if possible, and then the cautery applied over the whole 
raw surface. The best is the thermo-cautery of Paquelin. The 
platina is kept at a white heat constantly by forcing atmospheric 
air into the midst of a flame of benzine vapor. Next cover the 
surface with a thick pad saturated with glycerine, and a tampon 
over it if bleeding seems likely to occur. Let the pad be detached 
by suppuration. When this occurs, keep the vagina clean. Solu- 
tion of thvmol will no doubt be useful to correct the odor. To 



MALIGNANT GROWTHS. 15 I 

check the bleeding, should it occur, use a saturated solution of 
alum. Always use these solutions at a high temperature. Iodo- 
form, one drachm to an ounce of lard, will relieve pain, correct 
fetor, and diminish the diseased mass. 

PROF. E. S. DUNSTER, M. D., ANN ARBOR. 

In the Medical News, this author speaks very highly of chloral 
in these cases. He uses a solution of 10-30 grains to the ounce, 
with which he saturates a cotton wool plug, and applies it closely 
to the diseased surface. When required, it may be removed by 
means of a string attached to the plug. He claims that it corrects 
the odor, and also relieves the pains. 

DR. AUST-LAWRENCE 

Also recommends this remedy. He gives powdered ergot, 30 
grains every 6 hours, except when the patient is already reduced 
by loss of blood. 

[For a full discussion of the medical, palliative and cauterant plans of 
treatment of Malignant Growths, see Napheys' Surgical Therapeutics, Chap- 
ter XIV. See also Sir Jas. Y, Simpson's treatment under head of Mammary 
Tumors, part II.] 



STERILITY AND ANAPHRODISIA. 

These are separate conditions ; the former referring to infertility 
following the sexual act ; the latter to the absence of the subjective 
and characteristic nervous sensations which constitute the sexual 
orgasm. As both conditions may depend on a great variety of 
causes, these must in all cases be carefully sought out. 

The causes of sterility are defined by 

T. GAILLARD THOMAS, M. D., NEW YORK. 

To be — 

ist. Causes preventing the entrance of the semen into the 
uterus, absence or closure of the vagina or uterus by an obdurator 
hymen, atresia, conical os, polypi, etc. 

2d. Causes preventing the production of a healthy ovule, as 
ovaritis, cellulitis, etc. 

3d. Causes preventing the passage of the ovule into the uterus, 
as stricture or obliteration of the Fallopian tubes. 

4th. Causes destroying the vitality of the semen or preventing 
the fixation of the ovum, as endometritis, membranous dysmen- 
orrhea, menorrhagia, abnormal growths, etc. 

Dr. Thomas adds : 

" In spite of the fact that we have at our disposal many valuable 
resources for the removal of the causes which create sterility, 
were I asked to mention the part of the field of Gynecology, 
which yielded me the least satisfaction and the greatest disappoint- 
ment, I should cite this." 

Where any obstacle is present, the proper surgical operation 
may be performed, as imperforate hymen, atresia vaginae, occlusion 
of the womb in any way. The affection is a symptom only to be 
reached through the malady causing it. 

ELY VAN DE WARKER, M. D., NEW YORK. 

This writer in a paper on anaphrodisia, or, as he terms it, " im- 
potency " in women (Am. Jour. Obstetrics, January, 1878), sums up 
the causes and divides them into three groups : 



STERILITY AND ANAPHRODISIA. 15 3 

I. — Mental, subdivided into : 

a. Congenital psychical defects. 

b. Temporary mental conditions. 

c. Sexual incompatibility. 

II. — General physical causes. 

a. Debility resulting from constitutional and other dis- 

eases not sexual. 

b. General defective development. 

c. Lactation. 

III. — Conditions of the sexual organs and near parts. 

a. Defective development and result of injury. 

b. Dyspareunia (Barnes), resulting from (i) uterine dis- 

placement: (2) hyperemia of the uterine body ; (3) 
ovarian inflammation or congestion ; (4) colpitis 
either simple or specific; (5) spasmodic contraction 
of the vagina (vaginismus, Sims); (6) vascular tuber- 
cles of meatus urinarius; (7) diseases of the rectum, 
as fistula, fissure, or inflamed piles or ulcers. 

c. Deranged nervous system from uterine displacements 

and other chronic uterine diseases, and debility from 
exhausting discharges and chronic uterine disease. 

d. Morbid growths. 

e. Delayed or arrested menstruation. 

The treatment of these conditions should, of course, be in the 
main etiological. 

GRAILLY HEWITT, M. D., LONDON. 

This author gives as causes of this condition, abnormal condi- 
tions of the hymen ; narrowness or partial closure of the ostium 
vaginas, or vaginal canal; tumors interfering with intercourse, as 
an enlarged clitoris; spasms of the ostium vaginae; absence or 
imperfection of the uterus, chronic hypertrophy, closure of the os 
like a valve, one lip being larger than the other, flexions, etc.; dis- 
eases of the ovaries; altered conditions of the Fallopian tubes; ill- 
timed sexual intercourse, as women have a greater aptitude to con- 
ceive immediately after menstruation has ceased — this is the best 
time for intercourse ; masturbation, too frequent intercourse, and 
diseases of the rectum. 

Leucorrhea, when alkaline or acid to excess, would cause ster- 
tility. 



154 DISEASES OF THE UTERUS AND ITS ANNEXES. 

Sexual frigidity cannot be regarded as causing barrenness, as 
the reverse is constantly seen in practice. General debility and 
anemia, but especially the opposite, overfeeding and luxuri- 
ous habits, are especially liable to interfere with conception. The 
fecundity of the human race is diminished by the life prevalent 
among the rich, and augmented by the habits and spare diet of 
the poor, in the proportion of six to one. To ascertain the cause 
of sterility, it is necessary to examine into the history and ante- 
cedents, the manner of menstruation, and the general bodily 
health. The cure depends upon the removal of the cause, if this 
be possible. 

PROF. E. J. TILT, M. D., LONDON. 

Too much hair on the upper lip would lead to a suspicion of 
some defect of the ovaries. In sterility, occurring in too stout a 
person, fine her down by exercise, mental labor, and a diet from 
which bread, butter, milk, sugar, beef and potatoes are to a great 
extent excluded. The strong sympathy between the breast and 
the womb confirms the idea that by exciting the former the latter 
may be powerfully stimulated.- Dr. Chas. Loudon states that four 
out of seven women were thus enabled to become mothers. Dr. 
Marshall Hall suggests the application of a strong infant to the 
breast, and Dr. Bayes advises the use of a breast pump, two or 
three times a day. If passion be too intense, it may cause barren- 
ness ; and this has subsided and pregnancy followed after the pro- 
longed use of cold hip baths, cooling injections and camphor. 
Again, intercourse seems to act as a poison to the nervous system, 
causing unconsciousness, headache, and utter prostration, even for 
days. In such cases the influence is lessened by previous at- 
tempts to induce orgasm. Temporary" separation sometimes is 
useful, as giving to intercourse the stimulus of novelty. In East- 
ern countries, castor, ambergris, cantharides and aromatics, are 
employed. When consulted, the physician should see to the 
health of both parties, employ tonics, keeping them apart, and let 
intercourse occur just after the menstrual flow. 

Dr. Thomas Edis mentions cases where sterility was removed 
by connection in the genu-pectoral position. 



NYMPHOMANIA. 

The form of genital erethism which is currently known under 
this name, is usually symptomatic of disease of the ovaries, of the 
uterus, or of vaginal or vulvar pruritus. In all cases, close study 
of its causative relations is demanded, with a view to their re- 
moval. In general treatment, the genetic sedatives mentioned be- 
low, especially the potassic bromide, should be exhibited in full 
closes. 

Occasionally the disease 4s distinctly of centric origin, depend- 
ent upon obscure cerebral or cerebellar disorganization, when it is 
to be considered as one of the symptoms of mania, and treated 
accordingly. 

In some rare cases (one mentioned in the Trans. Gyn. Soc. of 
Boston) it is marked and persistent, without any other defect either 
of the local or general health observable. In such instances, the 
treatment can only be tentative. 

RESUME OF REMEDIES. 

Camphora and its monobromide have each considerable power as anaphro- 
disiacs, especially the latter, gr. iv., in capsules, three or four 
times a day. 

Cannabis Indica is a powerful sedative, with special influence on the 
uterus and its annexes, in relieving hyperesthesia and reducing 
hyperemia. 

Conium. Dr. Alfred Meadows observes ( Brit. Med. Jour., July, 1 879) 
that of all the anodynes we possess, none can compare with 
conium as an anodyne to the generative or sexual organs. It 
calms vascular excitement and moderates ovulation itself. Gr. j. 
of the alkaloid conia may be used in a vaginal pessary nightly. 

Digitalis lessens the flow of blood to the generative organs, and in some 
cases acts very satisfactorily. 

Ether. Dr. Laurence Turnbull combines ether with camphor in ab- 
normal sexual excitement : 

1 56. fy. Vitelli ovi, f.|ij 

Pulv. camphorse, 5ij 

Aetheris, f.^ij. M. 

Add the ether to the camphor, and then the emulsion. Dose, 
a tablespoonful every two hours. 

Ferri Bromidum acts moderately in sexual erethisim, but less efficiently 
than the potassic bromide. 

ess) 



I56 DISEASES OF THE UTERUS AND ITS ANNEXES. 

Hyoscyamus. Tilt combines camphor with hyoscyamus. 



157. ty. Camphorae, 


gr. ij 


Ex. hyoscyami, 


gr- J- 


For one pill. Two or three, thrice daily. 








M. 



Lupulina has been found effectual as an anaphrodisiac, in doses of six to 
twelve grains several times a day. 

Potassii Bromidum is par excellence the sedative of the reproductive 
system. Dr. Alfred Meadows believes that by its steady use 
we may limit ovulation, and indeed absolutely suspend the func- 
tion altogether and produce in time an atrophy of the ovary 
{Brit. Med. Jour., July 12, 1879). T ne dose should be not 
. less than 5ss three times daily. 

Zinci Bromidum is given by Charcot as an anaphrodisiac in doses of 
gr. v-xx., daily. 

Clitoridectomy, as practised by the late Mr. I. Baker Brown, of Lon- 
don, is justifiable where other means fail, and the cause appears 
to be local irritation. 



CHAPTER III. 

DISEASES OF THE VAGINA, URETHRA, AND 

BLADDER. 

s 
Synopsis of Diagnostic Points- - Vaginitis, Acute and Chronic, Non- 
specific — Vaginitis, Specific, Gonorrheal — Vaginismus and Dys- 
parennia — Vaginal Grozvths — Pruritus Vulva? and Vulvitis — 
Cystitis, Acute and Chronic — Urethritis — Urinary Disorders — 
Irritable Bladder, Dysiiria, Polyuria, Ischuria, Enuresis, Vesical 
Tenesmus, etc. 

SYNOPSIS OF DIAGNOSTIC POINTS. 

VAGINITIS. 

In the various forms of vaginitis, the chief difficulty in diagnosis 
is to distinguish gonorrheal from simple inflammations. Dr. N. 
L. Galabin, however, asserts [Diseases of Women, 1879), that a 
conclusion based upon the following signs, or the majority of them, 
will be right in ninety-nine cases out of a hundred. 

Gonorrheal vaginitis is characterized by — 

1. Its sudden onset. 

2. The markedly yellow or greenish color, offensive smell, and 
irritating quality, of the discharge. 

3. The smarting on micturition produced by extension of the 
inflammation to the urethra. 

4. The occurrence of inflammation or abscess in the vulvo- 
vaginal glands, the ducts of which can often be distinguished as 
injected points just in front of the hymen or its remnant. 

5. Marked oedema of the vulva and buboes. 

6. The communication of contagion to the male. 

When most of these are present, the case is almost, but not 
entirely, certain to be one of specific infection. 

(157) 



I $8 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

Dr. Lombe Atthill says, speaking of the two forms of vagini- 
tis: " I must avow that I know of no means of distinguishing with 
any certainty between the two " [Diseases Peculiar to Women, 

P- 37)- 

An almost pathognomonic sign of gonorrheal vaginitis, accord- 
ing to Mr. Tait, is oedema of the vulva. All cases of specific ori- 
gin do not present it; but where it is present, it may be considered 
the strongest proof of infection ; and where this is combined with 
a high degree of pain and scalding, especially during micturition, 
the case may be considered as beyond doubt of infectious origin. 
The discharge in such cases is profuse, purulent, and not glutinous, 
and the mucous surface of the vagina is of a yellowish red color; 
whereas in non-specific or catarrhal vaginitis, the discharge is 
scanty and tenacious, and the mucous surfaces of a purple hue. 

CYSTITIS. 

The principal local signs of inflammation of the bladder are 
pain, tenesmus, and frequent desire to urinate, followed by straining 
as if the organ had not been fully emptied. The pain is usually a 
dull ache in the perineum and the sacrum. Frequently the color 
and odor of the urine are little changed; mucous sediment is usu- 
ally present. 

The frequent urination diners from that seen in pregnancy and 
prolapsus by not diminishing when the recumbent position is as- 
sumed. The presence of tenesmus differentiates it from that wit- 
nessed in abdominal tumors, pelvic peritonitis, and inflammations' 
of the urethra. Palpitation and percussion of the abdomen will 
develop tenderness of the bladder, if it exists. The catheter or 
sound will distinguish cystitis from the pressure of stone or other 
foreign body in the bladder. And the endoscope affords a means 
of ascertaining the exact appearance of the interior of the bladder 
and urethra. 

Dr. E. J. Tilt observes ; " What one man calls chronic cystitis, 
another calls irritable bladder," so closely, in many instances, do 
these conditions shade into each other. 

URINARY DISORDERS. 

The functional disorders of the bladder are divided into the fol- 
lowing forms : 



SYNOPSIS OF DIAGNOSTIC POINTS. 159 

1. Polyuria — frequent urination and in considerable quantity. 

2. Ischuria — difficult urination and imperfect emptying of the 
bladder. 

3. Dysuria — painful urination. 

4. Enuresis — incontinence of urine. 

5. Vesical tenesmus — spasmodic pain after urination is com- 
pleted. 

6. Vesical Irritability — frequent and painful micturition, with the 
passage of very little urine. 



VAGINITIS, ACUTE AND CHRONIC-VAGINAL CATARRH- 
LEUCORRHEA-COLPITIS. 

Of the general means at our disposal to combat vaginal affec- 
tions, the following survey is given by 

DR. A. LEBLOND, OF PARIS. * 

Vaginal Injections. This writer observes that the temperature 
of vaginal injections has much to do with their effects. Taken 
cold, they produce an afflux of blood to the pelvic basin, and are 
thus stimulant ; while taken warm, their action is sedative. The 
dangers which some writers have referred to as attending vaginal 
injections are probably owing to the fluid being thrown into the 
uterus ; this can largely be avoided by using a syringe the aper- 
tures at the end of which are on the sides, and not at the extremity 
of the nozzle. When there is much inflammatory action in and 
near the vagina, the fluid should be thrown in very gradually, as 
long as ten or fifteen minutes being consumed in an injection. 
In such inflammatory conditions, injections of infusions and solu- 
tions of hyoscyamus, belladonna, etc., are often employed with ad- 
vantage ; these should always be administered lukewarm, as cold 
applications in such conditions may lead to injurious reactions. 

Vaginal Irrigations. These may be either of liquids, as water, 
plain or medicated ; or of gases, as carbonic acid gas or the vapors 
of chloroform, ether, etc. A variety of apparatus has been em- 
ployed at various times, which need not be here described. 
Whichever one is used, the irrigation should continue at least half 
an hour at a time to be efficacious. 

In uterine neuralgia and dysmenorrhea, advantage has been de- 
rived from injection of chloroform vapor into the vagina and 
uterus. This may be done by the apparatus devised by Scanzoni, 
or by means of a bottle with a large cork, into which two tubes 
are introduced, the one connected with a vaginal canula, the other 
with a hand ball for forcing air. The chloroform is poured on 
some cotton in the bottom of the bottle, the cork inserted, the 
canula introduced into the vagina, and the vapor driven in by 

* Traite de Chirurgie Gynecologique, Paris, 1879. 
(160) 



VAGINITIS, ACUTE AND CHRONIC. l6l 

pressing the ball. The injection of chloroform vapor sometimes 
produces considerable irritation of the vaginal walls, and it there- 
fore must be used with caution, and not of much strength. 

Medicated Tampons. These are valuable in many forms of 
vaginitis. They should be long, so as to separate the vaginal 
walls throughout their whole extent, and made of dry wadding. 
They are medicated with glycerin, the glyceroles, alum, tannin, 
saponified coal tar (which has been highly extolled by M. Siredey), 
or other substance. 

The proper introduction of the tampons can only be done with a 
speculum. Their extraction will be facilitated by anointing them 
with cerate or oil. They should not be allowed to remain in for 
many hours at a time, lest they interfere with urination. In ex- 
tracting them, patience and care, and the free use of warm water, 
are often necessary to avoid painful dragging, or laceration of the 
delicate lining membrane of the vagina. 

Vaginal cataplasms. At one time this method of medication: 
was much employed, but of late years has fallen out of use. The 
neatest and most effectual are prepared from wadding soaked in* 
infusion of fuciis crispns. It is to be had ready prepared from, 
pharmacists, in the form of sheets. A piece about three inches- 
square is cut off, moistened with warm water, rolled into the form, 
of a cylinder, and a string being attached to facilitate its withr- 
drawal, it is inserted into the vagina by the hand or a poi'te-tampon ■.. 
To be efficacious, they should be renewed daily, and without inter- 
ruption, for considerable time. They have been found valuable in* 
many inflammatory affections of the vagina and os. 

Vaginal suppositories, or medicated pessaries. These have been 
familiar to the profession from the earliest antiquity. The excipi- 
ent may be cerate, cocoa-butter, or petroleum products containing 
sufficient paraffin to give consistency ; the active ingredient is bel- 
ladonna, morphia, iodide of lead, etc. The most appropriate size 
is an inch and a half in length, and three-fourths of an inch in cir- 
cumference. They can be introduced daily by the patient herself. 
As the absorptive power of the vaginal mucous membrane is very 
slight,* they are less efficacious than rectal suppositories. 

*Dr. Hamburger, however, and some other writers, have maintained that: 
the absorptive power of the vaginal surface is considerable. The general 
assumption is that it is one-half that of the rectum. As the fact rests uncer- 
tain, caution should be exercised in using the more potent drugs, 

1 1 



1 62 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

LOMBE ATTH1LL, M. D., OF DUBLIN. 

In sub-acute vaginitis, this author states that a mode of treat- 
ment of the greatest value is by the application of glycerin. With 
this a roll of cotton wadding, with a strong thread attached, is 
saturated, introduced into the vagina through a speculum, and left 
for twenty-four hours. The glycerin, by its affinity for water, 
produces a copious, serous discharge, which in a marked degree 
relieves the congestion that exists. 

Dr. Atthill does not employ either alum or sulphate of zinc 
in vaginal injections where any inflammation is present. They 
both coagulate the albumen in the discharge, and cause much 
discomfort. Borax is better, as 

158. ^. Sodii biboratis, 3j 

Aquae, Oj. M. 

In some cases, much benefit will be derived from adding tobacco, 
gr. xv-xxx, to this amount; or when the patient is nauseated by 
the tobacco, one ounce of hops may be substituted. 

Where there is no vaginal irritation, but only a profuse and 
weakening leucorrheal discharge, astringents, such as alum or sul- 
phate of zinc, 5j, to water, Oj, will often -prove very useful. So 
also will decoction of oak bark, although this has the objection of 
staining the linen. 

J. P. THOMAS, M. D., OF KENTUCKY. 

This writer (Richmond and Louisville Medical Journal, Sept., 
1879) describes a medicated pessary, partaking of the emollient 
and soothing effects of a poultice, which he has used with success 
in erosions of the os and cervix uteri, and of neighboring parts 
of the vaginal surface. It is based on a formula of Dr. Rezin 
Thompson's, and is as follows: 

1 59, fy.. Pulv. ulmi corticis, lib 

Pulv. ipecac, et opii, §iij 

Bismuthi subnitratis, §ij 

Pulv. sassafras rad. cort., §iv 

Balsami copaibas,, §iv. M. 

The powders are to be intimately mixed by passing them suffi- 
ciently often through a gauze sifter. The copaiba is to be thor- 
oughly incorporated with the powder, and water gradually added 
until the mass by constant working or kneading acquires the 



VAGINITIS, ACUTE AND CHRONIC. 163 

consistency of stiff dough; then roll into balls from one to two 
inches in diameter, according to the desired size or shape of the 
pessary. When the balls are perfectly round, place them on a 
smooth board in the sun, or if cloudy, under a stove, to partially 
dry. When they begin to feel hard, moisten them slightly and 
smooth and close any cracks that may have formed, and after 
a few hours manipulate them into any form desired. Before 
introducing them they should be dipped in warm water. 

T. FINCH, M. D., OF ILLINOIS. 

160. I£. Potassii chloratis, 3iv 

Potassii permanganatis. gr.x 

Aqua;, Oj. M. 

Inject a teacupful morning and evening, in acute vaginitis. Warm 
sitz-baths and saline laxatives are important accessories. ( Chicago 
Medical Examiner, December, 1874.) . 

DR. EDIS, OF MIDDLESEX HOSPITAL, LONDON. 

In the subacute form of vaginitis this writer recommends swab- 
bing the vagina freely with strong carbolic acid. A speculum is 
inserted, and the fundus vaginae first touched ; the speculum being 
gradually withdrawn, the acid is allowed to come into contact with 
the whole length of the vagina, stopping short just before the junc- 
tion of the mucous membrane with the vulval outlet, otherwise 
intense burning pain will be produced. Care must be taken not to 
allow any excess, of the acid to run down externally. It is well to 
insert a pledget of cotton-wool soaked in oil just within the orifice 
of the vagina to prevent this ; but should much burning pain ensue, 
the patient is directed to squeeze a little olive-oil into the passage, 
and to insert a morphia suppository per anum. In several instan- 
ces, this method of treatment had been adopted with marked 
success ; two or three applications, at most, arresting the discharge, 
after several weeks' ineffectual treatment with ordinary lotions. 

PROF. SCANZONI, VIENNA. 

This author recommends, in vaginitis, the employment of a 
tampon rolled in powdered alum. If the sensibility be too acute, 
the alum is to be mixed with two parts of sugar. The tampon 
should not remain in the vagina longer than twelve hours, and 
ought to be introduced every two or three days. When it is with- 
drawn, the vagina should be cleansed by warm-water injections, 



104 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

and a bath taken. Some physicians replace the alum tampon bay 
sachet of gauze filled with an astringent powder, such as oak bark. 

SIR CHARLES CLARKE, OF LONDON. 

This distinguished physician often prescribed the following 
internally in protracted leucorrheal discharges. It is also highly 
praised by Dr. S. Ash well in his work on Diseases of Women : 

161. ]£. Infusi cascarillse, f.Jj 

Aquae pimentae, f.^ss 

Tinct. sabinae comp., f-3i-U 

Syr. zingiheris, f.3j. M. 

For one dose 3 times daily ; a blister to the sacrum. 

DR. BUYS, OF BORDEAUX. 

This author [Bordeaux Medical, 1873) recommends in chronic 
discharges fro*m the vagina the following injection : 

162. J£. Tincturae iodmii, gtt. 45 

Acidi carbolici, gtt. 6 

Glycerinae, f,^j 

Aquae destillatae, f^vj. M. 

For a vaginal injection. 

PROF. TRELAT, PARIS. 

The following has been extolled by Professor Trelat, in vaginal 
leucorrhea : 

163. 1$l. Acidi carbolici "pur., gr.xv 

Aquae coloniensis, |j 

Aquae, §ij. M. 

With this he moistens a tampon, and carries it to the bottom oi 
the vagina. After the surfaces have been cleaned by the use of 
this, he substitutes for it a milder preparation, as 

164. ty. Acidi tannici, 3j 

Glycerinae, f.g. M. 

To be applied on a tampon. 

DR. A. A. BOINET, PARIS. 

165. ^. Tincturae iodinii, f.^iij 

Acidi tannici, 3j 

Potassii iodidi, 3ss. M. 

This solution is employed to paint the vagina, in acute or 
chronic vaginitis, and the uterine neck, in engorgement and ulcer 



VAGINITIS, ACUTE AND CHRONIC. 1 65 

ation. The proportion of the tincture of iodine is to be lessened, 
according to the character of the inflamed tissues and the effect 
that it is desired to produce. 

J. N. DEMARQUAY, M. D., PARIS. 

166. I£, Acidi tannici, gr.xv-xxx 

Glycerinae, f\3ijss. M. 

Tampons of wadding immersed in this solution are introduced into the 
vagina after the acute symptoms have been relieved by baths, emol- 
lient injections, and repose. 

M. MAISSONNEUVE, PARIS. 

167. I£. Fern sulphatis, 5ijss 

Aquae, s Oj. M. 

This solution is advised in injections in vaginitis. After each 
injection, a certain quantity of starch is to be introduced into the 
vagina. 

EDMOND LANGLEBERT, M. D., PARIS. 

168. I£. Tincturse iodinii, f.3v-x 

Aquae destillatae, Oij 

Potassii iodidi, q. s. to prevent the precipi- 
tation of the iodine. M. 

A useful injection in vaginitis after the acute stage has passed. 
Ulceration, if any exist, should be lightly touched with nitrate ot 
silver. If the vaginal discharge be offensive, the following injection 
*s useful : 

169. IL Liquoris sodae chlorinatae, f.^vj 

Aquae destillatae, Oiss. M. 

E. J. TILT, M. D., OF LONDON. 

This author states that whether vaginitis occurs spontaneously 
or as the result of uterine catarrh, it is best cured by the injection 
of a solution of nitrate of silver. His usual solution is one of 
forty grains to the ounce, and he directs that the patient be placed 
on her back, a small glass speculum introduced as far as possible, 
and an ordinary glass syringeful of the solution be injected. The 
speculum is then to be very gradually withdrawn to the vicinity of 
the vulva, after the fluid has been left in contact for two or three 
minutes; then the speculum is to be removed, and the fluid re- 
ceived into a small cup. Or, a speculum may be applied, and as 
it is withdrawn, the sides of the vagina are freely touched with 



1 66 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

the toughened stick of silver nitrate, after the plan of Ricord in 
granular vaginitis. 

These measures recommended by Dr. Tilt seem unnecessarily 
severe. Dr. A. Courty [Maladies de /' Uterus et de ses Annexes, 
1866), advises to begin with a solution of gr. xv to water f.5j ; al- 
though he adds that it may be increased to gr. xxiv or even to gr. 
xlviij. He insists, especially, that the vagina shall be carefully 
washed and wiped with cotton through the speculum before the 
caustic solution is applied. 

dr. guipon, PARIS. 

170. IL Ferri sulphatis, 5ij 

Ferri subcarbonatis, 5iij 

C inchonae pulvens, 

Canellae pulveris, 

Ergotinae, aa 5j- M. 

One or two pinches to be administered before the two principal meals, 
in idiopathic leucorrhea. Its usage is to be suspended on the ap- 
proach of the menstrual epochs. Prolonged vaginal injections, 
morning and evening, with cold water and vinegar. Tonic regimen. 

171. I£. Acidi tannici, gr.ix 

Cerse albas, 3vj 

Adipis, B'w. M. 

Melt by a slow heat, and cool in a mould. 

This is a useful vaginal suppository in leucorrhea. 

LAWSON TAIT, F. R. C. S., BIRMINGHAM. 

This author warns against the use of vaginal injections in acute 
vaginitis on account of the risk of causing endometritis and ova- 
ritis. He considers no remedy equals the steady application of 
hot fomentations of acetate of lead and opium, the same drugs 
being inserted into the vagina in the form of soluble pessaries. 
When the acute stage has passed, pessaries of cocoa-butter con- 
taining tannin or acetate of lead are useful ; after that, injections of 
a four per cent, solution of permanganate of lime will establish a 
cure. 

In chronic forms, which do not extend to the uterus, brushing 
the whole surface with equal parts of glycerine and carbolic acid, 
followed by the use of an astringent pessary of acetate of lead or 
sulphate of zinc, will speedily effect a cure. 

Dr. Neftel, of New York, has called attention' to several cases 
of intense vaginitis, coincident with lead-poisoning from the use of 
cosmetics, and which disappeared under the internal use of iodide 
of potassium and sulphur, without local medication of any kind. 



VAGINITIS, ACUTE AND CHRONIC. * 1 67 

HENRY M. FIELD, M. D., OF BOSTON. 

Atony of the vaginal walls. This condition is quite common, 
accompanied or not by a leucorrheal discharge. Frequently this 
may be relieved by astringent vaginal suppositories, as 

172. R. Acidi tannici, gr.x 

Butyri cocoas, q. s. M. 

For one suppository. One daily. 

For this, borax or alum may be substituted. The borax is a 
mild astringent and local tonic. The extract of rhatany may also 
be used with excellent results {Jour. Gyn. Soc. Boston, Vol. VI). 

RESUME OF REMEDIES. * 

INTERNAL REMEDIES. 

A 'umen, in doses of gr. v-viij thrice daily, in combination with piiulse 
aloes or with nitre (gr.x), is productive of good in some obsti- 
nate cases of leucorrhea. 

Alkalies are often of value in correcting acrid discharges from the va- 
ginal membranes. 

Cantharides. The use of the tincture, once so highly praised by Dr. 
Dewees and others, has fallen into comparative disuse. It was 
given in gtt. xx thrice daily, in a demulcent draught, the dose 
being subsequently increased to gtt.xl— 1, until it produced slight 
strangury, when it was diminished or the medicine discontinued. 
The average period of cure was about four months. 

* Copaiba is highly spoken of by a number of writers, in doses of rnxv 
thrice daily. 

Cubbs have been employed with success. 

Ergot, in doses of gr.v thrice daily, often gives good results, especially 
if a blister be applied to the sacrum. 

Gallcn Pulvis, in doses of gr.x-xx, in decoction of tormentilla, daily, is 
given with great benefit at the Lock Hospital, London. 

Hannatoxyli Lignum, in decoction, has been employed with advantage. 

Juniper us frequently exerts a beneficial influence. 

Krameiia. The extract, in doses of gr xx daily, often arrests the dis- 
charge and improves the tone of the system. 

Potassii Nitras. Dr. Dewees prescribed the following with success in 
some obstinate cases : 

173. ty. Potassii nitratis, 5 V 

Aluminis, 5ijss. M. 

Divide into thirty powders ; one thrice daily. 

Pulsatilla, tincture, gtt.v thrice daily, is said by Phillips quickly to 
relieve leucorrhea attended by pain in the loins, depression and 
derangement of the nervous system. 



I 58 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

Safo'nahas been recommended (F. 101). Its use is most promising in 

obstinate leucorrheal discharges. 
Tannicum Acidum, in doses of gr. ij-i:j twice or thrice daily, in aqueous 

solution, combined with a small portion of dilute nitric acid, 

has been found an efficacious remedy. 
Terebinthince Oleum is recommended, in small and repeated doses, by 

Dr. Pereira, in chronic cases, unattended by inflammatory 

symptoms. 



VAGINAL INJECTIONS. 

Acidum Salicylicum Injections of salicylic acid have been used 
feet satisfaction in all discharges from the vagina. 
This formula is offered: 



r ith per- 



174. R. Acid, salicylic, 5iss 

Glycerinae, f.5iij 

Aquae, Oij. 
Sig. — For six injections. One daily. 

In uterine catarrh the canal should be injected by means of a 
catheter small enough for the purpose. The acid should be well 
dissolved in the liquid, for obvious reasons. This method is 
highly recommended in the treatment of chronic blennorrhagia, 
and it is said to succeed perfectly. 
Aloes. French writers have lauded in chronic and obstinate vaginitis, 
especially of blennorrheal origin, injections medicated with tinc- 
ture of aloes. (Forms agrives, Th'erapeutique Appliqu'ee, Vol. 

n.-) 

*Alutncn. Dr. Tyler Smith, of London, has found the following injec- 
tion very serviceable : 

175. i^. Aluminis, ^ss 

Acidi tannici, 5j-ij 

Aquae, Oij. M. 

One-half to be used at night, and the other half in the morning 

Oak bark decoction also makes a good vehicle : 



176. I£. Aluminis, 

Decocti quercus albae, 



5j 
Oj. 



M. 



Dr. E. J. Tilt, of London, remarks that he has repeatedly 
known the prolonged use of alum injections produce an irrita- 
able, sub-inflammatory state of the cervix uteri ; he advises, 
therefore, when astringent injections are long continued, to use 
those of alum, zinc, and sugar of lead, on alternate days. Le- 
blond notes that it hastens the exfoliation of the vaginal epithe- 
lium, and curdles the albumen in the discharges, and is objec- 
tionable on these accounts. Dr. Atthill never uses it when 
any inflammatory action is present. 
Ammonii Murias has occasionally been used in vaginal injection ; 



VAGINITIS, ACUTE AND CIIKONIC. 1 69 

177. ty. Ammonii muriatis, 3i-i v 

Aquae, Oj. M. 

Argenti Nitras, in solution, has been advised as a vaginal injection : 

178. I£. Argenti nitrat is, gr.iij 

Aquae destillatae, f.^ij. M. 

This agent, once very popular, is now much less so. Att- 
hii.l remarks that better results can almost always be obtained 
by other means, and this is the general opinion. 

*Bismuthi Subnitras, applied once a day in powder, on a small piece of 
charpie, by means of a speculum, to the whole of the vaginal 
mucous membrane, is an effectual remedy in some cases. Or it 
may be mixed into a thick cream with glycerine, and applied to 
the whole of the vaginal membrane. 

Ca'ci's Aqua. The vaginal injection of a weak solution of lime-water 
sometimes effects a cure after the failure of other remedies. 

Catechu. The infusion, injected once or twice a day, often greatly 
lessens the discharge. 

Co c cuius Indicus is recommended by Phillips, when the discharge is of a 
sero-purulent character, with pain in the lumbar region, gtt.v-x 
of the tincture, two or three times a day. 

Cupri Sulphas. The following injection, given after previously washing 
out the vagina with soap and water, is of service : 

179. 1£. Cupri sulphatis, gr.xx-xxx 

Aquae tepidas. Oss. M. 

To be used thrice daily. 

Feculum. Dr. George H. Bixby, of Boston, has recommenced starch 
injections in vaginal inflammation {Jour. Gyn. Soc. Boston, 
Vol. V). His formula is — 

180. I£. Thin boiled starch, ]/ 2 pint 

Pulv. chlorate of potash, 1 teaspoonful 

Glycerine, 4 " 

Use by injection every night, or twice daily. 

Ferri Chloridi Tinctura, 5j to a pint of water, forms an excellent astrin- 
gent injection. 

Glycerina, as dilute solution, as an addition to other medicaments, exerts 
an excellent effect. It increases the discharge, but relieves con- 
gestion. 

Granati Radicis Cortex. The decoction of the root-bark (fij, aquce Oij, 
boiled to Oj) is a useful vaginal injection, combined with alum: 

181. ^. Aluminis, 5j 

Decocti granati radicis' corticis, Oj. M. 

Hydrargyri Chloridum Corrosivum. Dr. Dewees employed the follow 
ing solution as a vaginal injection in obstinate leucorrheas : 



I70 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

182. $. Hydrargyri chloridi corrosivi, gr.j 

Aquae, i.^ij. M. 

It should be used with great caution, as even at this strength it 
may act most painfully on the surface. Milder means are 
safer. His directions are that it is to be used only in chronic 
cases ; given at first only once a day, then several times a 
day, until heat and irritation occur, when lotions of acetate of 
lead will effect the cure. 

Iodinium. Dr. Tilt gives : 

183. 3£. Tinct. iodinii, 

Tinct. opii, aa f.§ij. M. 

Two or three teaspoonfuls to be added to a pint of water, to be 
used once or twice a day. 

Matico. The infusion has been injected with benefit. 
Plumbi Acetas. The following is a useful vaginal injection : 

184. I£. Plumbi acetatis, g r - v j 

Aquas, f.^j. M. 

Plumbi Subacetas is preferred by Dr. Tanner in the following solution, 
the whole of which is to be used twice a day : 

185. ty. Liquoris plumbi subacetatis, f.5ij 

Aquae, Oj. M. 

Potassii Chloras. The following vaginal injection has been employed 
with success : 

186. I£. Potassii chloratis, 5j 

Aquae destillatae, f.^viij. M. 

Potassii Pei'tnanganas ■, in dilute solution (gr. v. to aquas f.£j) is undoubt- 
edly very beneficial in many cases, especially where the discharge 
is fetid. An objection to it is that it stains the linen. 

Pulsatilla. 5j of the tincture to Oj of water, is recommended by Phil- 
lips for a daily enema in obstinate leucorrheas. 

Quercus Alba. The decoction, with or without alum, is a safe and effect- 
ive vaginal injection. 

Sodii Boras. Dr. Grailly Hewitt, of London, advises, when the dis- 
charge is acrid, frequent ablutions of the external parts with a 
borax lotion, to prevent irritation. Atthill believes that it is 
both astringent and tonic. The usual strength is 5j to water 
Oj. 

Sodii Carbonas. Dr. S. Ashwell states that repeated experiments have 
shown that inflammation of mucous membranes always engen- 
ders a free acid on their surface, and that to neutralize this he 
and others have obtained almost immediate relief by the use of 
an alkali {Diseases of Women, p. 157). He recommends: 



VAGINITIS, ACUTE AND CHRONIC. I 7 I 

187. $. Sodii carbonat, 9j-£j 

Aquae, Oj. 

For a vaginal injection in leucorrhea. 

Tannin. This is one of the most popular substances for astringent injec- 
tions. The amount required is 3ss-j in a pint of cold water. 
Glycerine may be added. 

Thea. An infusion of green tea makes a good injection. 

Torment ilia. The decoction (3ij, aquae Oiss, boiled to Oj) is an excel- 
lent vehicle for alum, in vaginal injection. 

* Zinci Acctas. This salt forms a useful vaginal injection, in the strength 
of gr.ij-iv to aquas f.^j. The following was a favorite formula 
with Sir Astley Cooper : 

188. ^. Zinci sulphatis, g r - v j 

Liquoris plumbi subacetatis, nixxx 

Aquae, f.§iv. M. 

By this formula decomposition takes place, the acetate of 
zinc resulting. 
Zinci Oxicium. The following vaginal injection has been given with 
success : 

189. ]£. Zinci oxidi, ^ss 

Aquae, • Oij. M. 

Z,inci Sulphas, gr.j to water fjj, is beneficial where the inflammation is 
slight. 

Poultices. M. Fournier, of the Lourcine Hospital, Paris, makes use of 
voluminous cataplasms which quite distend the vagina ; and he 
states that he was first induced to resort to this practice by hav- 
ing observed the effects which had several times resulted from 
his pupils having forgotten to remove large wadding plugs that 
had been introduced. In each instance, these, so far from hav- 
ing acted prejudicially, had proved of service in treating vag- 
initis. 






VAGINITIS (SPECIFIC, GONORRHEAL). 

In the gonorrheal form of vaginitis, the treatment recommended 
by 

J. T. DARBY, M. D., OF NEW YORK, 

Is almost exclusively local {Archives of Clin. Surgery, June, 1878). 
Internal remedies are of no efficacy. The only proper treatment 
is a local one, and general treatment is only beneficial for the con- 
stitutional symptoms, or to make the urine less acrid and irritating 
to relieve the pain in micturition. Alkalies given by the mouth 
answer the latter indication. 

In a severe case of the disease, absolute rest, elevation of the 
hips, and the use of some local remedies, will assuage the pain and 
inflammation. The only medicines to be administered internally 
are to prevent the burning in the urethral tract. Dr. D. discards 
entirely copaiba, turpentine, and the like, as they do no good, 
while on the contrary they do harm by disturbing the digestion. 

Lotions applied to the part itself act as a sedative, of which lead 
lotion is the best where there is a good deal of inflammation with- 
out very much suppuration. Direct the patient to sit over a ves- 
sel, and then by means of a fountain syringe inject the parts well. 
The continuous application of cold is sometimes very beneficial. It 
the bowels are constipated, give a laxative to cause a free action ; 
common Epsom salts or seidlitz powder will do very well. We do 
not wish to cause a diarrhea, but simply to produce a few active 
movements so as to help remove the congestion. 

The diet should be regulated so as not to be too stimulating. 
Rice and milk with stale bread may constitute the food until the 
fever has abated. If the fever runs high, we may give tincture of 
aconite, or the tincture of gelseminum scmpervirens. This latter is 
one of the best remedies for the purpose in this disease. This 
agent has no specific influence on the disease, but it simply reduces 
the constitutional disturbance produced by a local cause. 

Sometimes the discharge is very profuse. In such a case, use 
warm water for the injections instead of cold. Where suppuration 
is abundant, the warm injections act better, and, moreover, they are 
much more comfortable to the patient. In addition to the warm 

(170 



VAGINITIS (SPECIFIC, GONORRHEAL). 1/3 

water injections, astringents may be used, such as acetate of lead 
or tannic acid. Opium may be combined with these remedies, as 
it tends to relieve the smarting they produce, and prevents pain by 
its direct action. 

Another remedy of considerable efficacy is chlorate of potassa. 
This may be used alone or in combination with the bromide of pot- 
assium. A very good prescription is the following: 

190. $. Potas. chlorat., 

Potas. bromid., aa ^ ss 

Aluminis, §j 

Aquae fervent, Oij. M. 

This is one of the best remedies to alleviate the pain and stop 
the discharge. 

JOHN MORRIS, M. D , OF BALTIMORE. 

This writer {Virginia Med. Montldy, Aug., 1878,) also believes 
that local remedies are chiefly to be relied on, though he has found 
cnbebs, administered internally, to prove very serviceable, particu- 
larly if the urethra or bladder is involved. Cubebs exercise a 
specific effect on the mucous surfaces, even when taken into the 
general circulation. He has, therefore, used this drug with advan- 
tage in both leucorrhea and specific vaginitis. The old-fashioned 
injection oi sulphate of zinc acts very well in mild attacks, if supple- 
mented by frequent injections of cold water. When the urethra 
or rectum is the seat of the inflammation, nitrate of silver is our 
most potent agent. When the disease creeps into the cervix uteri, 
internal injections of nitrate of silver and glycerin are our best 
means of cure. These cases are very intractable, and peculiarly 
painful when the Fallopian tubes and ovaries are included in the 
inflammatory process. Months, even years, are required ofttimes 
to effect a cure. In some cases, indeed, the disease is incurable, 
and remains as a lifelong affliction. When gonorrhea attacks the 
rectum, it is not only painful, but troublesome. Many weeks are 
required to effect a cure. It seems to exercise the same kind of 
virulence in this locality that it manifests when it attacks the con- 
junctiva, though, of course, the after consequences are not so 
serious. 

DR. GAUDRIOT, OF PARIS. 

191. I£. Zinci chloridi liquoris (Fr. codex), gtt.v 

Morphiae sulphatis, gr. y^ 

Mucilaginis, 

Pulv. sacchari albi, 

Feculi, q. s. M. 



174 DISEASES OF THE VAGINA, URETHRA AND BLADDER. 

Make one suppository. To be introduced into the vagina and retained 
by a bandage. The vaginal secretions dissolve the suppository, and 
the active agents are brought into contact with the membrane. 

LAWSON TAIT, F. R. C. S., BIRMINGHAM. 

Acute gonorrheal cervicitis or endo-cervicitis, is full of anxiety, 
for the disease may spread up the uterus and along the tubes to 
the ovaries. The patient must be kept rigidly in bed, and be 
treated by soluble pessaries of acetate of lead and opium, and 
general antiphlogistic remedies. On no consideration whatever 
should injections be employed in such a case, either vaginal or 
intra-uterine. 

Gonorrheal acute ovaritis is a common result of the injection. 
There is agonizing pelvic pain, generally on one side, and all the 
signs of a severe inflammatory attack. Micturition and defecation 
are often accompanied with excruciating pain. By administering 
an anaesthetic, a vaginal examination will reveal the enlarged 
ovary. The treatment should consist in leeches to the perineum, 
a blister over the ovary, diuretics, and small frequent doses of 
opium. The rectum should be well evacuated by an enema, and 
the bowels kept quiet for a few days. 

In cases of fading gonorrhea it is very common to find that 
pressure on the trigone gives a good deal of pain, and that the urine 
is alkaline and purulent. Injection of the bladder in these cases 
with weak solutions of carbolic acid or neutral acetate of lead will 
very rapidly effect a cure. 

In acute gonorrheal urethritis no application is so good as a 
morphia pessary ; the chronic form which is often left after the 
acute stage has passed is very easily cured by the application of 
equal parts of carbolic acid and glycerine on a probe armed with 
cotton wool. 

JOSEPH MULREANY, F. R. C. S., ENGLAND. 

Gonorrheal metritis. Where the gonorrheal inflammation ex- 
tends to the uterus, bringing on the complication of specific me- 
tritis, this writer [Half-Yearly Compendium, Vol. VIII.), prescribes 
at the outset dry heat to the abdomen, and internally a combina- 
tion of the alkaline carbonates, iodide of potassium and opium, in 
large and repeated doses, such as in the following formula : 



VAGINITIS (SPECIFIC, GONORRHEAL). 1/5 

192. fy. Pulv. potass, bicarb., 5ij ad 3iij 

Pulv. potass, nitratis, £)ij ad 3iss 

Sp. amnion, aromat., f. 3vj ad f.^j 

Potassii iodidi, 3ss ad 3j 

Syrupi zingiberis, f.Jj 

Aq. pur., ad f.^vj. M. 

A tablespoonful to be taken every one, two, or three hours, during the 
urgency of the symptoms. 

Sometimes he gives a dose of calomel, gr. v. ad gr. x., if there 
is a bilious taint either of skin or breath. Rarely are leeches 
necessary ; and at this stage he never uses injections. Within a 
few hours marked relief is obtained. The opium dominates the 
pain, and frees the system from its depressing influence : and the 
beneficial action of the alkahes on the blood, in this, as in many 
acute inflammatory affections, is most marked. He gives no alco- 
holic stimulants, and restricts the patient to a purely milk diet. 

The above treatment requires very little alteration in most cases, 
till a cure is effected. Another point in this plan is that the 
bowels are kept quiet. If they do not act for three or four days, 
so much the better, as by that means the inflamed and enlarged 
uterus is neither pinched nor disturbed by excessive peristaltic 
movement ; they of themselves, however, act about the fourth day; 
but if they do not, a dose of sod. et potas. tart, and rhubarb is 
sufficient to effect that object. 



VAGINISMUS AND DYSPAREUNIA. 

This common and distressing affection is frequently a neurosis, 
without visible cause ; but it is also, at times, owing to herpes, 
vaginal fissure, hypertrophied and painful papillae, mucous 
patches, or disease of the urethra. These various conditions re- 
quire appropriate treatment. 

F. WEBER, M. D., OF ST. PETERSBURG, 

Has found (Allg. Med. Zeitung, January, 1878), that the most com- 
mon causes of the affection, he thinks, are a rigid condition of the 
hymen, gonorrheal or catarrhal inflammation of the vagina, and 
also cicatrices, ulceration, or excoriation, of the vulva and outer 
parts of the vagina. 

Organic contraction should be treated by methodical dilatation, 
at first with compressed sponge, and subsequently with Fergus- 
son's specula, the size of which should be gradually increased. 
An ointment of belladonna is of great service at the same time. 
Inflammation of the vagina should be treated with cloths wet 
with a solution of sugar of lead, injections with or without opium, 
and belladonna suppositories. In the later stages, cauterization, 
with a solution of nitrate of silver, gives excellent results. This 
is especially serviceable when there are excoriations. Warm hip 
baths lessen the irritability of the nerves, and are of service. In 
addition to the local treatment, tonics and nervines should be used 
— especially bromide of potassium, iron, and valerian. When no 
local trouble is to be found, and the sufferings of the patient are 
very severe, division of the nervus pudendus, as recommended by 
Simpson and Sims, should be practised. The removal of the 
hymen itself or the myrtiform caruncule, Weber has never found 
necessary, though it has been repeatedly done by Sims and others. 

M. T. GALLARD, M. D., OF PARIS, 

Recommends where there is redness or excoriation of the mucous 
membrane, an iodoform ointment, as : 

193 ty. Iodoformi, 

Ol. theobromae, aa 3ss 

Axungiae recentis, 3iv. M. 

(176; 



m 



VAGINISMUS AND DYSPAREUNIA. 1/7 

If there is only pain, without any apparent alteration of the 
ucous membrane, he prescribes : 

194. R. Ext. belladonnas, gr.xlv. 

Axungiae recentis, gr.xlv. M. 

In either case he directs to be made plugs of charpie, as small 
as they choose to commence with, and in order not to frighten 
the patient, he charges her with the making of them, instructing 
her -to count the threads which enter into each of these plugs, to 
be introduced into the vagina each night, after being anointed with 
one or the other of the two ointments mentioned above. If at first 
she uses the iodoform, she Will be able, after a few days, to replace 
it by the belladonna, when the redness or excoriations or the 
eruption of the vulvar region has disappeared. Only, in either 
case, care must be taken to increase each day, by an imperceptible 
amount, but previously determined, the number of threads em- 
ployed, 10, 12 or 15, for example. So we shall secure, after a time, 
which will never be very long, the use of a plug of such size that, 
after having removed it, the place may be supplied by the virile 
member without the substitution causing any pain. He attributes 
the cure in these cases chiefly to the narcotic action of the unguents 
applied, though not denying that there may be advantage in the 
mechanical effect of the dilatation also. 

He utterly condemns all use of the knife in such cases, unless,. 
possibly, when the carunculae myrtiformes are inflamed, swollen or 
ulcerated, when he would sometimes admit the ablation of these as- 
a more speedy mode of cure than treatment by caustic only. 

DR. EUGENE BOUCHUT, PARIS. 

195. R.. Extracti krameria?, §ss 

Butyri cacaonis, ^j. M. 

Make twelve suppositories. One to be introduced into the vagina, 
night and morning. Valuable where there is vaginal fissure. 

PROFESSOR CARL SCHROEDER, OF ERLANGEN. 

Bathe the external genitals cautiously with dilute lead water, and 
afterward, when the redness has subsided, pencil the sensitive parts 
with : 

196. R. Argenti nitratis, 5ijss 

Aquae destillatae, t.fj. M. 

12 



\yS DISEASES OF THE VAGINA, URETHRA AND BLADDER. 

Or with, 

197. I£. Acidi carbolici, gr.x 

Aquae, f.|j. M. 

This was also the treatment preferred by Prof. Scanzoni, and in 
many instances it is entirely successful, and dispenses with the 
severe surgical measures introduced by Simpson, Sims, and others. 

W. H. BYFORD, M. D., CHICAGO. 

This writer treats vaginismus by applying the solid nitrate of 
silver to the vulva every ten or fourteen days, and in the interval, 
glycerine and tannin. The first application reduces the sensitive- 
ness decidedly, and it becomes less after each successive touch 
until finally cured. Rational general treatment should always 
accompany this local one. 

Mr. I. Baker Brown has noted that hyperaesthesia of the vagina 
is occasionally dependent on diseases of the rectum, especially 
fissure, and disappears when this condition is removed. (Surg. 
Dis. of Women}) 

As parturition would almost certainly relieve this condition, a 
simple and sure cure could be effected by fertile coition, carried 
out when the patient was thoroughly under the influence of ether. 

RESUME OF REMEDIES. 

Acidtim Carbolicu?n. (See. F 197). 
Argenti Nitrus, locally applied (F. 196). 
Atropia. Dr. Peaslee recommends : 

198. I£. Atropias, gr.ij 

Adipis, §j. M. 

For local use. 

Belladonna is useful at times (F. 194). 

Ice. The application of finger-shaped pieces of ice in the vagina is rec- 
ommended by Holst. 

Iodoformum is praised by Leblond and others. It may be given in 

suppositories, each containing gr.x 
Krameria has been employed by Bouchut (F. 195). 
Opium. A full dose of opium, or a hypodermic injection of morphia, 

will sometimes relax the spasm of the constrictor muscle, and 

relieve the symptoms (Fonnsagrives). 
Plumbum. Goulard's extract is often exceedingly soothing. 
Stramonium is occasionally beneficial. 






VAGINAL GROWTHS. 

The vegetations and warts which form on the labia may be re- 
moved by the knife or scissors. Dr. E. J. Tilt uses the latter, and 
touches the seat of growth with acid nitrate of mercury. The 
application to them of crystallized acetic acid is said to remove 
them without pain. 

For caruncle of the urethra, Dr. Wm. Goodell recommends the 
actual cautery, as a red-hot knitting needle. The after treatment 
is the application twice a week of the undiluted commercial car- 
bolic acid, which will prevent a crop of small growths springing 
up around the site of the parent growth. When the patient will 
not submit to the knife or the cautery, the next best procedure is 
to touch the growth twice a week with crystallized carbolic acid 
made fluid by heat. 

Dr. A. W. Edis recommends {Brit. Med. Jour., April, 1874), a 
saturated solution of chromic acid in these growths, applied as 
above mentioned for carbolic acid, and afterwards neutralized by 
pledgets of lint dipped in a strong solution of sodium carbonate 

For non-syphilitic warts and papillomatous growths of the vulva 
and parts adjacent, Dr. Henry G. Piffard, of New York (note to 
Phillips, Materia Medica,) has used with the utmost satisfaction a 
strong tincture of the arbor vitce, Thuja occidentalism applied to the 
part three times a day for a week or fortnight. 

Dr. Grailly Hewitt suggests the use of strong nitric acid or 
lunar caustic. Black wash, or a strong solution of iodide of 
potassium, should then be applied. 

Dr. G. S. Bedford removes these excrescences, or when small, 
sprinkles them once a day with : 

199. $. Cupri acetatis, 

Sabinae, aa gr.vj. M. 

Dr. F. J. Bumstead removes these growths, or, when quite 
small, touches them with glacial acetic acid, or fuming nitric 
acid ; as the eschar falls, repeating as may be necessary. In ob- 
stinate cases, he employs a solution of chromic acid 100 grains to 
the ounce. Or, corrosive sublimate in collodion 3j to f.Sj, may be 
applied over the whole surface. The perchloride or subsulphate 

(i79) 



l80 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

of iron often proves useful, applying it once or twice a day to the 
growth, which shrivels and falls, and a few applications will pre- 
vent its return. 

Where vegetations are flat and horny, Zeissl gives : 



Or. 



200. I£. Acidi arseniosi, gr.ij 

Ung. hydrarg., 5j- M. 



201. ^. Arsenici iodidi, gr.ij 

Ung. hydrarg., 3j. M, 



Dr. Peters, of Prague, has found the simple application of cold 
poultices to cause these growths to disappear, after they had re- 
sisted cauterization and even excision. 



PRURITUS VULV£ SEU VAGINAE, AND VULVITIS. 

The most common causes of itching of the vulva are pediculi, 
irritating vaginal leucorrhea, eczema, erythema, diabetes, vesical 
calculus, herpes tonsurans; abnormal growths, cervical endometri- 
tis, the presence of small bristly hairs on the vulva, seat worms, 
leptothrix vaginalis and simple nervous pruritus. In all cases the 
treatment, when practicable, should be with reference to the causa- 
tion in the particular case. 

s 

PROFESSOR CARL SCHROEDER, ERLANGEN. 

Of actual curative agents, this writer (Ziemssen's Cyclopcedia) can 
only speak with confidence of: 

202. fy. Acidi carbolici, gtt.iv-1 

Glycerinae, 

Aquae, aa f.^ss. M. 

Apply locally. 

He says of this combination : " I am sure that whoever has 
once tried this, will never return to any of the other remedies 
which have been recommended." 



M. 



Dr. Horatio R. Storer, of Newport, R. I., states that he has 
long given great comfort in this affection by Oldham's ointment 
of hydrocyanic acid and acetate of lead, with cocoa butter. 

Dr. G. S. Jones, of Boston, has employed with benefit, in pruri- 
tus of the vulva, the following: 

204. I£. Sodii biboratis, §j 

C amphorae, 5j 

Olei gaultheriae, gtt.xxx 

Aquae bullientis, Oij. M. 

When cool, pass through a cloth. To be used cold, as a wash for the 
parts, and as an injection into the vagina. 

For pruritus, produced by irritating leucorrheal discharges, Dr. 

(181) 



( A. C. GARRATT, M. D., BOSTON. 




203. ^. Acidi hydrocyanici (Scheele's), 
Liquoris plumbi subacetatis, 
Aquae, 

As a local application. 


f.Sij 
f.3iv 
f.?iij. 



I 82 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

A. R. Jackson, of Chicago, has used, with gratifying results, the 
following : 

205. I£. Zinci sulpho-carbolatis, §ss 

Aquae, t f.gviij. M. 

Wash the parts twice daily, leaving it to dry upon the surface 

PROF. MONTROSE A. PALLEN, M. D., NEW YORK. 

This gynecologist has found pruritus pudendalis in pregnancy to 
yield in nearly every instance, except when it depends on trophic 
neuric causes, to the application of thy inolized clay. 

206. I^. Thymol, gr.xv 

Vaseline, gr.xxx 

Powdered brick clay, §iij. 

Dissolve the thymol in the vaseline, and rub it up with the clay. 

This is introduced into the vagina or applied to the pruritic 
parts, to be washed out every day or two and replaced. Herpes, 
eczema, and kindred affections, so often encountered in the later 
months of gestation, are similarly benefited by this antisepsis, 
more particularly if produced by the acrid discharges from the 
cervix and vagina. {Richmond and Louisville Med. Journal, 1878.) 

In diabetic cases, Professor Winckel {Practitioner, Sept., 1876,) 
states that by the administration of Carlsbad salts internally, and a 
salicylic acid lotion externally, he can generally effect a cure. 

Dr. B. Hicks {Lancet, Vol. I, 1877^.456,) has made some good 
observations upon the same subject, and, also, on the very frequent 
association of eczema with diabetes. Codeia has proved most valu- 
able, in Dr. Hicks' hands, in allaying the irritation. Nothing 
approaches in value, according to Dr. Richard Neal, of London, a 
solution of boracic acid as a local application. Professor Hardy 
{Medical Times and Gazette, July, 1877, p. 98,) reports on prurigi- 
nous and other affections of the genitals in both males and females 
as symptoms of diabetes. That such symptoms are frequently 
associated with diabetes is certain. Well-marked instances of 
pruriginous vulvitis, where no trace of sugar exists in the urine, 
are, of course, of frequent occurrence. 

E. J. TILT, M. D., LONDON. 

Eczema genitale. Irritation and pruritus of the genitals is not 
unfrequently owing to an eczematous condition of their surface. 
This is especially the case in fat women of middle age with gouty 



PRURITUS VULViE SEU VAGIN/E, AND VULVITIS. 1 33 

antecedents. As lotions or as injections, when the eczema extends 
to the inner surface of the vagina, the following prescriptions are 
recommended : 

207. ty. Bismuthi subnitratis, 3»j 

Pulv. tragacanth., 3j 

Aquae, Oss. M. 



o. 



208. $. Zinci oxidi, 

Calaminae prep., aa 3ij 

Acidi hydrocyan. diluti, 

Glycerinae, aa f.3ij 

Liquorem calcis, ad f.^viij. M. 



Or, 



209. $. Zinci oxidi, 3j 

Glycerinae, 

Aquae calcis, aa f.^j. 

Rub up the zinc with the glycerine, and add the lime water. 

These lotions should be applied several times a day, and the 
parts may be anointed with petroleum ointment. Constitutional 
treatment addressed to the diathesis is very important in these 
cases. 

Mr. Lawson Tait says of eczema of the genitals that it is in 
some cases the most distressing disease he has ever witnessed. 
For its relief, it is necessary to determine whether it is due to the 
presence of parasites or of some irritating discharge from the 
vagina. He has repeatedly cured patients with chronic eczema of 
the genitals by first curing them of chronic endomlesitis. In el- 
derly women of gouty diathesis, colchicum and acetate of potassa, 
continued for some months, have relieved some bad cases. Local 
applications are often useful, but what suits one may not another. 
Puff powder, the cold sitz baths, simple cerate, Goulard's water, 
opiate fomentations, tarry preparations, etc., may be tried in turn. 
But the most generally useful applications he has found to be 
strong carbolic acid, and a concentrated solution of acetate of lead 
in glycerine. The carbolic acid must be used cautiously, and not 
over a large surface at one time; or it must be used weak, and its 
strength gradually increased. He has repeatedly seen one appli- 
cation of it relieve the patient for some weeks. If applied widely 
or in a concentrated form, the patient should be put under an 
anaesthetic. 



184 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

RESUME OF REMEDIES. 

LOCAL APPLICATIONS. 

Acidum Boracicum is praised in the diabetic form (p. 180). 

Acidum Sulphur os um. Lotions and injections of sulphurous acid have 
been found effective in cases dependent on vaginal discharges. 

Aconitia, in ointment, is approved by Dr. T. H. Tanner. 

Alumina Nitras. Dr. Gill, of St Louis, in the St. Louis Medical and 
Surgical Journal, recommends the use of nitrate of alumina. 
It has, in his hands, given more satisfaction than any other 
remedy. He orders four to six grains to the ounce of soft 
water, to be used as a vaginal injection or external wash, once 
or twice a day if necessary. 

Ammonii Marias', in the following ointment, is useful: 

210. fy. Ammonii muriatis, 5j 

Pulveris helleboris albae, §ss 

Adipis, §iij. M. 

Ammo nice Aqita sometimes succeeds in obstinate cases like a charm, when 
injected in diluted form into the vagina : 

211. I£. Ammoniae aquae, f-5ss-j 

Aquas, Oss. M. 

To be freely injected into the vagina. 

Aqua Calcis, applied warm, together with perfect rest and light clothing, 
will sometimes afford the desired relief. 

Aqua Fervida. One of the most efficient means in relieving the pruritus 
occurring in pregnancy is hot water, applied by means of flan- 
nel cloths wrung out of that fluid and laid upon the parts. 

Argenti Nitras. Dr. Grailly Hewitt, of London, states that in obsti- 
nate cases a rather strong cauterization of the os uteri, with the 
solid nitrate, will sometimes succeed when other measures fail. 
Dr. Charles, {Annales de Gynecologie) also speaks most highly 
of the application of the solid nitrate of silver in the treatment 
of vulva pruritus. The seat of the itching is oftenest near the 
clitoris, or in the nymphse, sometimes at the margin of the 
anus. It is necessary to cauterize freely, passing the crayon 
two or three times over the affected surfaces, and even some- 
what beyond them. Dr. Charles states that he has found, 
without a single exception, great relief from the first cauteriza 
tion, often a complete cure. Sometimes it is necessary to recur 
to the cauterization a second or third time after some days. 
Dr. Tilt rubs the parts for several minutes with a piece of 
cotton soaked in a forty grain solution of silver nitrate. 

Camphora, in powder, with starch, dusted over the parts, sometimes re- 
moves the distressing symptoms. 

* Carbolicum Acidum is exceedingly efficient in very many cases (F. 199). 

* Chloral, by Prof. J. R. Black, of Ohio : 



PRURITUS VULVjE SEU VAGINAE, AND VULVITIS. 185 

212. R. Chloral hydratis, 3iij 

Aquae, f.$iv. M. 

Apply locally. 

In cases of pruritus vulvae, where the cause seems to be attri- 
butable to irritation simply of the nerves, whether in the preg- 
nant condition or otherwise, Dr. C. O. Wright, of Cincinnati, 
{American Journal Obstetrics, July, 1879,) states that he knows 
of no remedy equal to the local application of chloral hydrate, 
either in solution or in the form of an ointment. Here it acts 
by direct contact, producing an anaesthetic influence upon the 
peripheral extremities of the nerves, and acting by reflex action 
upon the nerve itself. 
* Chloroformum. Dr. Grailly Hewitt, of London, obtains the greatest 
benefit from the application of: 

213. R. Chloroformi, f.^ss 

Olei amygdalae expressi, f". § i i j . M. 

Creasotum. A weak solution is sometimes useful. 

Ferri Chloridi Tinctura in varying strength will often be valuable. 
Byford recommends 5j to water Oj. and adds that it is especi- 
ally useful where there is no eruption, and when there is 
leucorrhea and a congested dark appearance of the mucous 
membrane. 

Hydrargyri Oxidi Rubri Unguentum, well diluted with cod-liver oil, is 
frequently an effectual application. 

* Hydrargyri Chloridum Corrosivum. The favorite formula of Erasmus 
Wilson, of London, is the following: 

214. R. Hydrargyri chloridi corrosivi, gr.v-x 

Spiritus rosmarini, 

Alcoholis, aa f.§j 

Misturae amygdalae amarae, f-^yj. M. 

Another formula, said to be effective, is given by Dr. Milton 
{Medical Press, March nth, ii 



215. R. Hydrargyri chloridi corrosivi, gr.iv 

Bismuthi oxidi, gr.xxx 

Acidi hydrocyanici diluti, HLxxx 

Aquam calcis, ad f.^viij. M. 

Apply warm, twice or thrice daily. 

Hydrargyri Unguentwn is advised locally by Dr. Ringer, of London. 
Hydrocyanicum Acidum Dilutum is recommended, largely diluted, by Dr. 

West, of London. It must not be applied too freely, nor over 

abraded surfaces : 

216. R. Acidi hydrocyanici diluti, r»lx-xl 

Glycerinae, f.§j. M. 

Iodinium. The tincture, locally applied, often affords relief. 



ISO DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

Mentha Oleum or Essentia. In the Medical and Surgical Reporter, Vol. 
XL., 1879, a writer reports a most obstinate case promptly re- 
lieved by the occasional application of essence of peppermint. 

Morphia, subcutaneously, deserves trial in severe cases. 

*Olivce Oleum, spread over the parts with a feather, sometimes allays the 
pruritus. 

Fix Liquida. A glycerole of tar sometimes succeeds : 

217. I^. Glycerine, 

Tar, aa y 2 lb 

Starch, y z oz. 

Heat the tar and glycerine separately, rub up the starch with 
the glycerine, mix, bring to the boiling point, and cool. 

Plumbi Subacetatis Liquor Dilutus. The following soothing application 
is a useful one : 

218. I£. Liquoris plumbi subacetatis diluti, f.5j 

Tincturae hyoscyami, f.5ij 

Misturae camphoras, f.§viij. M. 

To be applied tepid. Rest and an antiphlogistic regimen are at 
the same time to be ordered. 

Sodii Boras. The following formula is advised by Dr. West, of London : 

219. fy. Sodii boratis, 5iv 

Morphias muriatis, gr.viij 

Aquae rosas, f.^x. M. 

So dee Chloritiatce Liquor, diluted, has been employed with success : 

220. I^. Liquoris sodae chlorinatae, f-5 v j 

Aquae, f.gxij. M. 

Sodii Sulphis has been favorably reported on. 

221. I£. Sodii sulphitis, 3j 

Aquae, f.3iij 

Glycerinae, f.|j. M. 

Tabacum. Dr. Tanner recommends a lotion of an infusion of tobacco 

3ij to a pint of boiling water. 
Tanacetum. A poultice of tansey leaves applied as hot as the patient 

can bear it, is said, by Dr. R. L. Butt, of Alabama, to be 

efficient in obstinate cases. {American Practitioner, Aug., 

1877.) 
Thymol may be tried. (F. 206.) 
Zinci Oxidum. For erythema and pruritus vulvae Dr. Braun-Fernwald, 

of Vienna, recommends : 

222. I£. Unguenti petrolei, 5 grammes 

Unguenti cetacei, 3 " 

Zinci oxidi, 3 " M. 

An ointment for local use. 



CYSTITIS. 

E. J. TILT, M. D., OF LONDON. 

The first thing to do in an attack of ordinary acute cystitis, is to 
put the patient to bed; give a warm hip bath and warm vaginal 
injections; and if the pain is severe, leech the abdomen and cover 
with an anodyne poultice. A rectal suppository of opium, gr.ij, 
will give ease, and gr.v-x of extract of hyoscyamus a day, in pill 
form, is not to be omitted. The urine should be rendered bland 
by alkalies, and the patient should drink freely alkaline and muci- 
laginous fluids. 

Cystitis may be caused by pelvic peritonitis, by tumors of the 
womb or ovaries, by prolapse, procidentia, etc. In such cases 
these conditions must be remedied before permanent relief of the 
vesical inflammation can be expected. 

A. J. C. SKENE, M. D., OF NEW YORK. 

Existing constipation should be overcome by the free use of 
saline laxatives. The diet should be carefully regulated. An ex- 
clusive milk diet has been found sufficient to cure some chronic 
cases. 

Benzoic acid is perhaps the drug that will be found the most 
useful in the earlier stages in the largest number of cases. It 
often seems to act as a specific, giving speedy and permanent 
relief. 

223. I£. Acidi benzoici, 

Sodii biboratis, aa gr.x 

Infusi buchu, f.^ij. M. 

This amount three or four times a day. 

The borax is added to insure the solution of the acid. Benzo- 
ate of ammonia is more palatable, and acts equally well in the same 
dose. 

In the more advanced stages of the disease, balsam of Peru, 
copaiba, and oil of turpentine, are important remedies. They 
should be given in capsules, the same as in gonorrhea. When 
the pain is not severe and the urine is loaded with mucus and 
pus, astringents should be given, as the following, which Dr. S. 
has employed with good effect : 

(187) 



1 88 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

224. fy. Extract! buchu fluidi, f.^ij 

Tincturae conii, f.^j 

Morphias sulphatis, gr. iss. M. 

A teaspoonful every three or four hours. 

The salicylate of sodium and the sulpho-carbolates have been 
exhibited with advantage. 

In old and obstinate cases the bladder must be washed out and 
medicated injections used. Of these, the following may be em- 
ployed to relieve pain : 

225. I£. Chloral hydratis, gr. x-xv 

Aquae, f.fj. M. 

For an injection in this proportion. 

As astringents and alteratives, nitrate of silver, sulphate of 
zinc, tannic acid, and acetate of lead ; of either beginning with gr. 
i-ij to water f.gj, are the most efficient. When the urine is alka- 
line and offensive from long retention, nitro-hydrochloric acid, 
gtt.ij to water f.gj, should be used. 

In obstinate cases, nitrate of silver, gr.xx to water f.gj, is one of 
the most reliable remedies. Of this strong solution not more 
than five or ten drops should be used at a time. 

As a last resort in painful and incurable cases, Dr. Emmet has 
established an artificial vesico-vaginal fistula, which maintains 
complete drainage, and is sure to relieve and perhaps will cure. 
The same object may be accomplished at times by a permanent 
catheter. 

E. C. GEHRUNG, M. D., OF ST. LOUIS. 

In acute cystitis, and in acute exacerbations of chronic cystitis, 
this practitioner (St. Louis Courier of Medicine, Aug., 1879,) nas 
derived extraordinary advantage from elevating and fixing the 
bladder by means of filling the vagina with a cotton tampon. He 
uses dry cotton batting. He first surrounds the uterine neck with 
a few small wads of this substance. This is followed by a large 
wad or two, thoroughly compressed between the fingers to facili- 
tate the introduction into the vagina, where, when let loose, it will 
enlarge by its inherent elasticity and fill this cavity. Thus, after 
careful adjustment of these wads, the bladder will be elevated and 
compressed against the pubes and abdominal walls, so to speak, 
between two elastic media. 

The patient expresses herself as decidedly relieved, and can at 



CYSTITIS. 189 

once rise to her feet and feel comfortable. The tampon should be 
removed and re-applied twice or thrice in the twenty-four hours. 

S. F. GILBERT, M. D., OF ELYSBURG, PENNSYLVANIA. 

In severe cases, the use of injections of tannic and salicylic acids 
into the bladder, is recommended by this writer {Med. and Surg. 
Reporter, March 24, 1879). After washing out the bladder with 
warm water several times, he throws in the following : 

226. I£. Acidi tannici, gr.x 

Acidi salicylici, gr.ij 

Aquae, f.^iv. M. 

For an injection. Retaining it ten or fifteen minutes, then removing 
it and again washing the bladder out with warm water, to prevent 
the hardening of blood or mucus by the acids. 

GRAILLY HEWITT, M. D., LONDON. 

The timely use of the bladder, after labor, will prevent that 
destructive cystitis, which may be produced by inability to evacuate 
the bladder. When it is present, with fever, pain, and tenderness, 
leeches may be required. Demulcent liquids, as barley-water, 
should be used, and all irritants avoided. Rest is exceedingly 
important. In the chronic form, it is best treated with diheted min- 
eral acids ; uva nrsi and pareira brava are serviceable in combina- 
tion with diluted nitro-muriatic acid. Sir Henry Thompson used 
a decoction of the triticum repens in the male with great good 
results, and Dr. Hewitt has found it of equal service in women. 
He has seen great benefit from counter-irritation just above the 
symphysis. The general treatment is important. Some require 
liberal diet, others the reverse. 

PROF. ROBERT BARNES, M. D., LONDON. 

Diminish the irritating qualities of the urine; everything known 
to promote dyspepsia and lithiasis or oxalmia, must be avoided. 
Demulcents, then tonics, may be used. If lithiasis is present, use 
alkalies, as soda, potassa, or lithia. More commonly there is the 
phosphatic condition, with ammoniacal urine ; here give mineral 
acids and tonics in moderate doses. Warm baths often afford 
great relief when there is great pain or spasm. 



I 



URETHRITIS. 

E. J. TILT, M. D., OF LONDON. 

When the difficulty or pain of micturition is not relieved by 
diluents, warm hip-baths and poultices, urethritis may be suspected. 
In this case the urethra can be felt with the finger to be round, 
solid, enlarged, and painful to the touch. Cooling injections and 
mucilaginous drinks are called for, and if these do not answer, a 
tannin bougie should be introduced into the urethra three or four 
times, at five days' interval. 

Tannin bougies are made by dipping medium sized bougies into 
gum water, powdering them with tannin, letting them dry, and 
after rubbing off the roughness, dipping them in gum water previ- 
ous to using them. 

In the event of these failing, a stick of nitrate of silver may be 
rapidly passed into the passage. 

A. W. SAXE, M. D., OF CALIFORNIA. 

This writer describes catarrhal urethritis distinguished from 
gonorrheal inflammation by, 1st, the history of the case and moral 
probabilities ; 2d, by the absence of tenesmus in most cases of the 
gonorrheal variety ; and 3d, by the absence of that profuse muco- 
purulent discharge which is inseparable from the early stages of 
the gonorrheal disease. 

It would be difficult to say what remedies have not been used in 
the treatment of this affection in its various stages and phases. The 
catalogue includes nux vomica, pareira brava, buchu, uva ursi, 
vaginal injections and suppositories, opiates, prussic acid, copaiba, 
and cubebs, and lately, the injection of normal urine into the 
bladder, etc., etc. {Pacific Med. and Surg. Jour., Apr., 1874.) 

His plan of treatment is as follows : 

I st. Horizontal position in bed indispensable. 

2d. Hot applications to the feet, with hot diluent drinks, so as 
to induce diaphoresis, if possible. 

3d. The administration, every two hours, of the following: 

(190) 



URETHRITIS. 1 9I 

227. $. Hydrarg. chlor. mitis, gr. xxxvj 

Pulv. ipecac, gr. viij. M. 

Divide in chart. No. xij. Sig. — Dose one powder in a little syrup every 
two hours, until six are taken. Then follow with decoct, sennae, 
q. s., to induce action and free evacuation of the bowels. Diet very 
light and simple; drinks, mucilaginous ; decoctions of elm bark or 
flaxseed are best, and are rendered palatable by the addition of a 
little orange peel, sugar, tartaric acid, or lemon juice. 

The only sedative or anodyne admissible is a cold, wet napkin 
to the vulva, changed sufficiently often to insure a low temperature. 
Opiates are injurious. Chloral hydrate, gr. xv to xx, at night, less 
objectionable, is seldom necessary. 

If, after the first twelve hours, and after the bowels have been 
freely evacuated, there is s still much pain in passing the urine, or if 
there is any tenderness or tenesmus, the remaining powders should 
be given and followed by the laxative as before, after which it will 
be, in general, only necessary to keep the patient in bed for a few 
days, and to see that the bowels are kept open by neutral or alka- 
line salts every morning. This, with moderately improved diet 
and mucilages, will insure a perfect and speedy recovery. 

The pulverized ipecac, is a very important adjuvant to the 
alterative, but the quantity must be restricted to the tolerance of 
the stomach ; a half grain will be sufficient in all delicate stomachs, 
and in many it will be too much. But whatever the stomach will 
tolerate without emesis, is the maximum. 

THOS. ADDIS EMMET, M. D., NEW YORK. 

Keep the patient recumbent, the bowels free by salines, and the 
urine bland. Use hot water vaginal injections and warm sitz-baths 
Also wash out the urethral tract several times a day with warm 
water. After washing out the urethra, the extract of pinas cana- . 
densis, to which a little impure carbolic acid has been added, 
should be thoroughly applied. Sometimes the application of a 
weak solution of nitrate of silver, Or of impure carbolic acid, will 
be found useful. As the case improves, vaseline or a little tannin 
and glycerine will protect the parts sufficiently. 



URINARY DISORDERS-IRRITABLE BLADDER, DYSURIA 
POLYURIA, ISCHURIA, ETC. 

PROF. WM. GOODELL, M. D., PHILADELPHIA. 

In almost every form of vesical irritation, belladonna and its 
alkaloid atropia are valuable remedies. Dr. Goodell generally 
gives it according to the following prescription, which he can re- 
commend : 

228. ty. Atropiae, gr.j 

Acidi acetici, gtt.xx 

Alcoholis, 

Aquae, aa f.3iv. M. 

Four drops before each meal in a wineglassful of water. To be in- 
creased or diminished according to the constitutional effect. 

In that form of irritability which consists in an inability to hold 
the water on slight exertion, such as coughing, laughing, running, 
etc., the cause is generally relaxation of the fibres. Ferruginous 
preparations are here demanded, and with v them the best remedy 
is a combination of tincture of belladonna, tincture of nox vomica 
and fluid extract of ergot. If this fails, the next resort would be 
the application of carbolic or even nitric acid to the urethra, with 
proper hygienic treatment. 

A. J. C. SKENE, M. D., OF BROOKLYN. * 

Where the irritability is a pure neurosis, the general system de- 
mands most attention. Tonics, a well-ordered diet, change of 
scene and cheerful company, are required. The bowels should be 
kept moderately open, and small doses of strychnia administered. 
Locally, a cup of warm hop tea containing twenty to forty drops 
of laudanum may be injected into the rectum, or an opium sup- 
pository combined with belladonna or hyoscyamus; or the fol- 
lowing : 

229. ^. Chloral hydratis, gr.xv 

Aquae, f-lj— ij- 

For a rectal injection. 

Masturbation, malaria and hysteria, are occasional exciting 

* Diseases of the Bladder and Urethra in Women, New York, 1878. 

(192) 



URINARY DISORDERS. 1Q3 

causes of the complaint, and demand appropriate treatment. Ab- 
normal conditions of the urine are also frequent causes. In all 
cases the urine should be tested. If acid, alkalies are required. 
In excessive acidity with deposits of uric acid, the following is a 
very efficient combination : 

230. ty. Potassii b.carbonatis, 

Potassii citratis, aa ^ss 

Syrupi simplicis, §iv. M. 

Take a teaspoonful in half a tumbler of waier, adding §j of lemon 
juice. Drink while effervescing. 

In oxaluria the following prescription is looked upon by many 
as almost a specific : s 

231. I£. Acidi nitro-muriatici diluti, 5 v ~ v j 

Tincturse nucis vomicae, 3iij 

Olei gaultheriae, ""Ixij 

Aquam, ad f". §iij . M. 

A teaspoonful in water before each meal. Many of the slightly alka- 
line mineral spring waters will also be found of use. 

DR. JOHN S. WARREN, OF NEW YORK. 

Dysuria is common complaint among females, and may be ow- 
ing to vascular growths about the urethral meatus, inflammatory 
affections of the urethra, anteflexion, etc. (JV. Y. Medical Journal ', 

1878.) 

The growths are of all sizes and forms, varying from a slightly 
congested and hypertrophied condition of the mucous membrane 
of the canal to the size of a full-grown raspberry, to which indeed, 
it bears no small resemblance. It is generally situated at the 
meatus externus, and therefore, readily discoverable by an ocular 
examination after separation of the labia, though not infrequently 
it is a little further distant within, and in such cases he has made 
use of the ordinary ear-specula for their detection and treatment. 
This tumor may be pedunculated or sessile in growth, is a bright 
scarlet color, easy to tear and bleed, and, as a rule, exquisitely 
tender and sensitive to the touch; so that urination, coition, fric- 
tion from clothing or from washing, give the most intense pain 
and suffering. 

The treatment for the removal of these painful growths is exci- 
sion by the scissors, cauterization by the actual cautery, nitric or 
carbolic acids, the silk ligature, and the snare — the one used for 
aural purposes is best adapted, and is especially useful when the 
*3 



194 DISEASES OF THE VAGINA, URETHRA, AND BLADDER. 

caruncle is situated some little distance from the meatus; here, 
too, the ear-specula or a glass tube is very useful for caustic appli- 
cation to the diseased portions of the urethra; for when the growth 
is sessile in character, its complete destruction by a powerful 
escharotic, like nitric acid, or the actual cautery, is necessary. 

DR. BRABAZON. 

Iiritable Bladder. In this annoying complaint, this writer {Brit. 
Med. Jour., 1879,) has found the following injection of great 
service : 

232. fy. Argenti nitratis, gr.ij 

Extracti belladonnas, g r - v j 

Aquae destill., f.§ij. M. 

, For an injection. This solution should be injected twice a week, and 
allowed to remain in the bladder for about from three to five min- 
utes, and then withdrawn through the canula. Several months 
may be necessary for a cure. 

Incontinence of urine is often best treated by forcible dilatations 
of the urethra, for which Weiss' Female Urethral Dilator may be 
used. 

[For the treatment of Cystitis, Incontinence of Urine, Irritable Bladder 
and allied conditions, see Napheys' Surgical Therapeutics, Chap. XI.] 



PART II 



OBSTETRICAL 

THERAPEUTICS. 



CHAPTER I. 

THE DISORDERS OF PREGNANCY. 

The Hygiene of the Puerperal State — Abortion and Premature 
Labor {Prevention and Induction) — Vomiting and Nausea of 
Pregnancy — Sympathetic Nervous Disordei'S {Palpitation, Syncope, 
Neuralgia, Pruritus; etc) — Digestive Derangements of Pregnancy 
{Dyspepsia, Constipation, Diarrhea, Hemorrhoids, Albuminuria). 

HYGIENE OE THE PUERPERAL STATE. 

In order that the child-bearing woman may be enabled to give 
birth to a healthy offspring, that the act of delivery may be accom- 
plished with safety to both mother and child, and that her subse- 
quent getting up may not be impeded by debility, etc., it is 
absolutely imperative that, from the inception of pregnancy, she 
should be placed under the best hygienic surroundings. She 
requires an abundance of pure air, sunlight, moderate and careful 
exercise in the open air, plenty of nourishing and easily-digested 
food. 

Cleanliness must never be neglected ; tepid baths are always 
beneficial. 

While sedentary habits are always detrimental, great exertions, 
as dancing, horse-riding, or rough carriage-riding, must be equally 
avoided. 

There is no need of a special diet ; she requires to continue 
her usual food, merely eschewing anything hard to digest, or par- 
ticularly stimulating. The peculiar cravings incident to pregnancy 
may be indulged in moderation, unless they are for articles of a 
hurtful or doubtful character. Nor is it requisite to medicate her, 
save for the correction of abnormal conditions, as constipation, 
acid stomach, vomiting, etc. 

Tight lacing, or clothing too tight in any way, will not fail to 
prove injurious. 

In short, let her take the same precautions in the care of her 
health that she would take under all circumstances Mental 

(i97) 



I9S DISORDERS OF PREGNANCY. 

excitement in every form should be sedulously avoided, and she 
should be carefully surrounded by everything calculated to main- 
tain a tranquil, happy disposition. 

To prevent depressed nipples or any other condition of the 
mammae likely to interfere with the proper performance of their 
functions, these parts must be protected from pressure by tight 
clothing, or cold from an insufficiency of covering. 

Upon this subject we will speak at length in the proper order. 

GEORGE H. NAPHEYS M. D., OF PHILADELPHIA. 

This author, in his very excellent popular work on the hygiene 
of women, entitled The Physical Life of Woman, has collected 
together many valuable .suggestions as to the care of the health 
of pregnant women; and when such a work is desired by mar- 
ried persons for their instruction, none better can be recom- 
mended. His recommendations briefly are with reference to 

Food. This should be varied, light and nutritious, with a special 
regard to the idiosyncrasies of the person, which, it should be 
noted, are often quite different in pregnancy from the ordinary 
state. After the sixth month, an additional meal each day should 
be taken, so that the system can meet the unusual demands upon 
it for nourishment without overloading the stomach. 

Clothing. This should be loose, the attempt at concealment, by 
tight dresses, so often made by young mothers, being especially 
avoided. Flannel drawers should be worn when the pregnancy 
is advanced. Pressure upon the lower limbs in the vicinity of the 
knee or the ankle joint should be avoided, more particularly dur- 
ing the last months. It is apt to produce enlargement of the 
veins, and finally varicose ulcers. The garters should not be 
tightly drawn, nor the gaiters too closely fitted, while yet they 
should firmly support the ankle. 

Exercise. Dancing, lifting, carrying heavy weights, and similar 
forms of exercise, should be avoided. The same is true of horse- 
back exercise and driving over rough roads. Journeys should be 
taken as little as possible. The vibrating motion and sudden jars 
incident to railroad traveling, often produce nausea and faintness; 
sea-sickness, with its violent vomiting, not infrequently leads to 
premature labor. Frequent short walks are the best form of 
exercise. 

Sleep. A larger amount of sleep than usual is demanded in the 



HYGIENE OF THE PUERPERAL STATE. IQ9 

pregnant condition. Women should then lie abed late, and retire 
early, and a nap during the day is to be recommended. Late in 
pregnancy some women experience a sense of suffocation on lying 
down. They should sleep on a bed-chair, or propped up on 
pillows. 

Mental Condition. Severe study, anxiety, and all exciting emo. 
tions and absorbing intellectual pursuits, should be suspended dur- 
ing pregnancy. The usual wide variations in the mental state, the 
feeling of despondency and that of exhilaration, should both be 
tempered by judicious representations of the groundlessness of the 
one and the risk of the other. The senses should not be over 
stimulated by rank odors, loud noises, or extremely sapid condi- 
ments. 

Marital Relations. In the earlier months of pregnancy these 
may be moderately continued, except about the periods when the 
woman, if not pregnant, would have had her menses. In such 
cases the molimen is present, and coition tends to increase it and 
lead to abortion. In the last three months of pregnancy it is gen- 
erally wiser to abstain wholly from sexual approaches. 



ABORTION AND PREMATURE LABOR. 

PROF. W. S. PLAYFAIR, M. D., EDINBURGH. 

This author believes that we may hope to prevent an abortion if 
there is no dilatation of the os and the hemorrhage has not been 
excessive. But if the os be open, the finger can touch the ovum, 
and pains are present, the indication is that the ovum must be ex- 
pelled. Place the patient in bed, keep her cool, give her light 
diet. She should not rise for any. purpose. To avert uterine con- 
tractions, no remedy is so useful as opium, given freely and repeat- 
edly, either in the form of the tincture or of Battley's sedative 
solution, say 20 to 30 minims, repeated in a few hours. Chloro- 
dyne is still better, in doses of 15 minims every third or fourth 
hour. If advisable, as from irritability of the stomach, this may 
be given in starch by the rectum. The patient should be kept 
under the influence of the remedies for several days, until all 
symptoms have disappeared; at the same time avoid constipation, 
itself a source of irritation, by small doses of castor oil, or other 
gentle aperients. 

Dr. R. P. Harris, American editor of Dr. Playfair's work, 
speaks emphatically of the value of opium in these cases. 

As a prophylactic of the tendency to abortion, remove the causes 
when known, as a syphilitic taint and constitutional debility. Re- 
troflexion of the uterus may be relieved by a pessary, until the 
uterus has risen out of the pelvis. 

Syphilitic infection should always be inquired for, where fre- 
quent abortions occur, and both husband and wife should be 
placed under anti-syphilitic remedies. Diday insists that at each 
impregnation the mother should be thus treated, even though she 
exhibit no traces of the disease. Thus we may hope that infec- 
tion of the ovum may be prevented. 

In fatty degeneration of the chorion villi and other morbid states 
of the placenta, preventing proper nutrition of the foetus, nothing 
can be done save to improve the mother's health. Simpson recom- 
mends chlorate of potass a when the child habitually dies in the 
latter months of pregnancy, with the idea of supplying oxygen to 
the blood. The theory is doubtful, though the drug may act well 
as a tonic. It maybe given in doses of 15 to 20 grains three 

(200) 



ABORTION AND PREMATURE LABOR. 201 

times a day, and advantageously combined with dilute hydro- 
chloric acid. 

Where no appreciable cause can be discovered, prolonged rest, 
at least until the time has passed at which abortion usually has oc- 
curred, will give the best chance for its avoidance. Care will be 
necessary lest the health suffer from want of fresh air and exercise. 
The rest should be extremely strict at the menstrual periods ; in the 
intervals, she may lie on a sofa and spend part of the time in the 
open air. Sexual intercourse should be prohibited. 

When abortion is inevitable, we must favor the expulsion of the 
ovum. When the os is dilated, the pains strong, the ovum sepa- 
rated and protruding, depress the uterus from above by the left 
hand, and scoop out the ovum with the examining finger. If be- 
yond reach, administer chloroform, pass the entire hand into the 
vagina, and the finger into the uterus. This is safer and more sure 
than the use of any form of ovum-forceps. When this fails, or the 
os is not dilated, plug the vagina. The best plan is with pledgets. 
of cotton wool soaked in water. Each should be soaked also ins 
glycerine to prevent the offensive odor which otherwise will arise. 
In six or eight hours remove the plug and insert a fresh one if 
requisite. Two or three full doses of liquid extract of ergot, f.5ss- 
to f.5j each, or a subcutaneous injection of crgotine, may be given. 
These two excitants of uterine action, the plug and the ergot, 
often effect complete detachment, and the ovum is readily removed, 
when the plug is withdrawn. When dilatation does not readily 
occur, it may be aided by tents, especially the sponge, which also 
acts as an effectual plug. 

As long as the placenta or membranes are retained, septicemia 
is likely to occur, therefore it is important that they should be re- 
moved ; and in the event of delay, fetor, and decomposition may 
be prevented by the use of intra-uterine injections of diluted Con- 
dy's fluid ; not more than a drachm or two should be thrown in at. 
once, and the os must be sufficiently patulous, or injury may re* 
suit. 

A. J. C. SKENE, M. D., OF NEW YORK. 

This writer [Half-Yearly Compendium, July, 1876,) sums up the- 
rules of practice in abortion as follows : 

1. Where the symptoms of abortion are slight, and of short 
duration, efforts should be made to arrest it. 



202 DISORDERS OF PREGNANCY. 

2. During dilatation of the os, opium should be given, if there 
is any call for it, and ergot should be carefully avoided. 

3. Hemorrhage should be controlled by tamponing the cervix, 
the hydrostatic dilator being the best for that purpose. 

4. When the os is fully dilated, and the ovum is not properly 
expelled after the use of ergot, it should be removed by the for- 
ceps and curette. 

5. Post-partum hemorrhage should be arrested by ergot and 
the intra-uterine tampon. 

The inflammation of the uterus, peritoneum, or cellular tissue, 
which may arise, should be treated on general principles. 

PROF. WM. LEISHMAN, M. D., GLASGOW. 

In some cases, it would seem as though the uterus had con- 
tracted a habit of abortion; hence we must tide over this period, 
and thus break up the habit. 

The strictness of rest must be proportioned to the number of 
abortions ; in obstinate cases, nothing but absolute confinement to 
bed will suffice. When irritations arise, liable to act reflexly on 
the uterus, these must be removed, as diarrhea, skin or bladder 
troubles, or even toothache. Caution the patient against tight 
lacing. When hemorrhage commences, rest on a hard mattress 
must be enjoined. The food should be non-stimulating, and meat 
sometimes is best avoided. Opium is the sheet anchor. Chloral, 
by the mouth or rectum, has been employed with success. Until 
the fcetus is known to be dead, act as though it were living. 
When, however, abortion is inevitable, as shown by discharge- of 
the liquor amnii, profuse hemorrhage, and violent pains, in the 
first three months, the less we interfere the better, for experience 
shows that the ovum will generally escape entire, while manipula- 
tions may only serve to rupture the membranes, and thus cause 
retention of a part or the whole. Plug the vagina for hemorrhage, 
as suggested by Dewees, with a large sponge filled with vinegar. 
Astringents are sometimes given with good effect, as acetate of 
lead, gallic acid, and the mineral acids. In more advanced preg- 
nancy, oxytocics come into use. A simple enema or one contain- 
ing turpentine will aid to excite uterine contractions. The placenta 
generally occasions the most difficulty. When this is retained, 
and the os closes, we must wait; the finger cannot be introduced, 
and ergot is of no use. Symptoms must be met as they arise. 



ABORTION AND PREMATURE LABOR. 203 

When dilatation occurs, or severe flooding; demands action, careful 
effort must be made to bring away any portion that may protrude. 
More reliance should be placed upon fingers than instruments. 

After an abortion, the health should be built up by tonics as 
demanded, and fatigue and exertions should be avoided for a while. 

ALFRED MEADOWS, M. D., OF LONDON. 

Ergot is exhibited by this author in habitual abortion dependent 
upon a weakened atonic condition of the uterus (Practitioner, Sep- 
tember, 1868). He commences in small doses (TT|v-viij extracti 
ergotse liquoris, British Pliarmacopccia), as soon as pregnancy is 
known to exist, and continues it in increasing doses (TTj^xx-xxx), 
as long as it may seem necessary, certainly till after the period of 
the accustomed abortion, but with the occasional omission of a 
week or two. In unsuitable cases, this mode of treatment may be 
productive of mischief; for, as Dr. Meadows remarks, its employ- 
ment is a matter of extreme delicacy, requiring a very careful dis- 
crimination of the cause of previous abortions, and of the actual 
present condition of the uterus. 

On the general use of opium in abortion, it may be concluded, 
from the evidence offered, that it is of value in threatened abortion 
arising from accident, from mental causes, or from habit, when it 
may be given by the mouth, or in a cold starch injection thrown 
into the bowel, repeated every night, or oftener, according to cir- 
cumstances; the application of cold, perfect quiet, and unstimulating 
diet, being at the same time enforced. When, however, abortion 
is threatened from foetal disease or imperfection, so that the prema- 
ture emptying of the uterus is but an effort of nature to get rid of 
that which she cannot accomplish, opium does harm, by retarding 
the emptying of the uterus, which must sooner or later take place. 
After abortion has taken place, opium allays excitement, tranquilizes 
the circulation, and procures sleep. 

ROBERT BURNS, M. D., OF PHILADELPHIA, 

Speaks highly of arsenic as a hemostatic, in doses of twenty 
minims of the liquor potassae arsenitis, at intervals of half an hour, 
until some decided effect is produced. 

When gestation has reached the fifth month, the membranes 
may be punctured to lessen the hemorrhage and facilitate expul- 
sion. It is better to leave a portion of the membrane, etc., than to 



204 DISORDERS OF PREGNANCY. 

employ forcible extraction, unless the discharge be excessive or 
offensive; then any fragments should be removed, and the vagina 
and uterus washed out with warm water. Generally, when all is 
away, the hemorrhage at once ceases. Even a very small portion 
will serve to keep up the discharge, and this is a valuable point 
for diagnosis and treatment. Prophylaxis will consist in local 
depletion and saline purgation in blood stases ; support and tonics 
for debility; quiet, especially at the menstrual epochs; avoidance 
of sexual excitement, and sedatives when required. Chalybeate 
tonics are to be avoided, as encouraging abortion, though in ane- 
mia they are undoubtedly of great service. 

Tanner, and Laferld, of Malta, regard assafcetida as a uterine 
tonic in weak, irritable women, where there is an absence of vas- 
cular congestion; ergot acts in this way, and may be given in doses 
of ten minims of the liquid extract every four, six or eight hours, 
and for two or three weeks at about the time when the abortion is 
expected from previous experience. In syphilitic taint, bicliloride 
of mercury is invaluable. 

PROF. KARL SCHROEDER, M. D., ERLANGEN. 

To prevent the abortion, the woman should remain constantly 
in the dorsal position, and a few full doses of tincture of opium 
should be given by the mouth or rectum. When profuse hemor- 
rhage threatens the life of the mother, the tampon, mineral acids 
and ergot, internally, and vinegar and cold water to the abdomen. 
The caoutchouc tampon is objectionable as it, when filled, only in- 
creases the tendency to dilatation of the os and uterine contrac- 
tions. Lint pressed against the bleeding, surface adheres and 
checks further flow; hence a small tampon will often suffice. In- 
troduce the speculum, open it widely, and pack the lint entirely 
over the bleeding cervix, and then fill in behind this ; withdraw 
the speculum while holding the plug closely in place with a long 
rod. At the end of six hours remove the tampon and reapply it if 
necessary. The hemorrhage may thus be entirely checked, or the 
ovum may be found lying loose within the cavity. As this method 
does not increase uterine action, hope may be entertained, even 
yet, of saving the ovum. 

To remove the ovum, when necessary, Honing recommends 
the compression of the uterus by combined manipulation. Two 
fingers of the one hand are brought into the anterior vault of the 



ABORTION AND PREMATURE LABOR. 205 

vagina, and placed against the body of the uterus, while the other 
hand presses from outside upon its posterior wall. Or, the uterus 
may be pressed from outside against the symphysis. This method 
of expulsion succeeds easily and perfectly. 

After the hemorrhage is over, the patient is to be treated as a 
parturient woman If the ovum was putrefied, or decomposing 
shreds are found, injections of tepid water or infusion of chamo- 
mile should be used thrice a day. 

J. G. SWAYNE, M. D., PHYSICIAN ACCOUCHEUR TO THE BRISTOL 
GENERAL HOSPITAL, ETC., ENGLAND. 

The following formulae are of service in cases of accidental hem- 
orrhage during pregnancy : 



233. fy. Acidi sulphurici diluti, 


f-5j 


Tincturae opii, 


irtxl 


Infusi rosas compositi, 


f.§vj. 


Two tablespoonfuls every other hour. 




234. I£. Plumbi acetatis, 


gr.xviij 


Acidi acetici, 


TTJ.XX 


Morphias acetatis, 


gr.j 


Aquae destillatae, 


£5vj. 



M. 



Two tablespoonfuls every hour. 



The woman is also, of course, to be kept in a recumbent posi- 
tion, and cold compresses applied to the abdomen and vulva. 
Cold drinks and cold water enemata may be administered. By 
the employment of these expedients, the bleeding may be checked, 
and the patient carried in safety to the close of her pregnancy. 

PROF. FLEETWOOD CHURCHILL, M. D., DUBLIN. 

At an early stage, this author has repeatedly found the tincture 
of Indian hemp in doses of 5 or 6 drops every 2, 4, or 6 hours, to 
check the hemorrhage. The usual remedies failing, and the abor- 
tion being inevitable, and the hemorrhage becoming alarming, he 
employs, for the removal of the ovum, an instrument consisting of 
a steel rod divided into three claws at one extremity, which ex- 
pand widely when set free. This is enclosed in a small flexible 
catheter, and the claws are thus closed ; when retracted, the claws 
open. The ovum may thus be seized without danger to the 
uterus, and where it is impossible to introduce the hand. The 
introduction of the hand into the vagina and the fingers into the 
uterus is not free from danger. Dewees employed a wire crotchet 



206 DISORDERS OF PREGNANCY. 

to bring away the ovum, but the placental forceps of Dr. Henry 
Bond, of Philadelphia, are perhaps the best for the purpose. 

In cases of great flooding, the plug becomes necessary, and 
where the ovum is still retained, x / z drachm doses of ergot may be 
given occasionally. 

INDUCTION OF PREMATURE LABOR. 
CLEMENT GODSON, M. D., OF LONDON. 

This writer (St. Bartholomew's Hospital Reports, 1875,) enumer- 
ates the following as the methods proposed for inducing premature 
labor : 

1. Evacuation of the liquor amnii by puncturing the membranes 

2. The administration of certain drugs, particularly ergot of rye. 

3. The injection of water into the vagina. 

4. The injection of water within the uterus. 

5. The injection of atmospheric air or carbonic acid within the 
uterus. 

6. Galvanism. 

7. Irritation of the mammae, by means of cupping-glasses. 

8. Separation of the membranes from the uterine wall, as far as 
is practicable, with the finger. 

9. Insertion of a long gum-elastic catheter between the mem- 
branes and the wall of the uterus. 

10. Dilatation of the vagina by means of air-bags. 

11. Dilatation of the os uteri by air-bags. 

12. Dilatation of the os uteri by means of sponge tents. . 

Most of these are open to the objections that they are uncertain, 
or hazardous, or have unpleasant sequelae. 

Most of them are practiced in such a manner as to force on too 
hurriedly the uterine contractions; and that which consists in the 
evacuation of the liquor amnii stands self-condemned, as depriving 
the womb, at the very outset, of the all-important dilator provided 
by nature. 

Dr. G.'s mode of procedure consists in insinuating, night and 
morning, between the cervix uteri and the membranes, sponge 
tents of gradually increasing size; the first, and each succeeding 
one, being as large as the parts will admit. On removing each 
tent, and before replacing it by another, a warm douche, contain- 
ing Condy's fluid, is administered. He has found the use of one, 



ABORTION AND PREMATURE LABOR. 20/ 

two, and three tents, to be sufficient, and has never had occasion 
to employ more than four. 

The instrument by means of which the tent is placed in posi- 
tion is made for him in London. It is fully described in the Lan- 
cet, April 2 2, 1 87 1. 

It entirely obviates the use of the speculum, and being provided 
with what is equivalent to a universal joint, it enables the tent to 
be pushed, without extraneous guidance, between the cervix and 
the membranes, taking of itself the readiest path presented to it. 
For the same reason the membranes run no risk of puncture. The 
tents themselves are short, rounded at the extremity, and perfora- 
ted, to facilitate adaptation to the instrument. 

The apparatus, and the mode of its application, are so simple, 
and so free from inconvenience and danger, that its use causes in 
practice little or no anxiety on the part of the patient ; and until 
labor sets in, she moves about without pain or inconvenience, re- 
gardless of the presence of the tent. 

PROF. W. M. LEISHMAN, M. D., GLASGOW. 

The rupture of the membranes by means of a quill or in any 
other way, is a certain and effectual method, but open to serious 
objections. It compromises, very decidedly, the chances of the 
child, by allowing pressure upon it to the end of the labor. 
Again, if the os is imperfectly dilated, the membranes may be 
retained with a fatal result to the mother. 

Prof. Hamilton, of Edinburgh, recommends separation of the 
membranes by a finger or the sound passed within the os uteri. 
This may, however, be solely due to the forcible dilatation of the 
os, and which may be equally successfully done with tents. Most 
operators prefer, as safe and efficient, the introduction of an elastic 
catheter within the uterus and outside of the membranes, up a dis- 
tance of six or seven inches, and allowed to remain. Sooner or 
later, the uterus is stimulated to contract 

An equally safe method is the use of Braun's colpeurynter, 
Gariel's air pressary, or other form of plug. Vaginal or uterine 
injections are made by directing a constant stream of warm water 
upon the os by means of a long tube. Some allow a free egress 
for the water, others endeavor to retain it so as to act in detaching 
the membranes. This is repeated once or twice a day, and gener- 
ally brings on contraction after eight or ten applications. It is by 



208 DISORDERS OF PREGNANCY. 

no means free from risk, and full egress should always be allowed 
for the fluid. 

The intra uterine douche is effective, though doubtful as to 
safety. 

The most recent method is that of Barnes; dilatation of the os 
by means of graduated fluid pressure. He makes two stages — 
provocative and accelerative. For the first he passes an elastic 
bougie six or seven inches into the uterus, coils up the remainder 
in the vagina, and lets it remain. Next morning there is gener- 
ally some uterine action ; or it may be suffered to remain. Before 
rupturing the membranes, adapt a binder to the abdomen tightly, 
so as to keep the head in close apposition to the cervix. This 
often prevents the cord being washed down. Dilate the cervix by 
the medium or large bag till it will admit three fingers ; rupture 
the membranes, introduce the dilator, and expand till the passage 
is open for the child. If there is room, and there are pains, leave 
the rest to nature. Otherwise, use the accelerative method — the 
forceps or turning; or, if the passage of a living child is hopeless, 
craniotomy. Twenty-four hours in all from the insertion of the 
bougie should see the termination. The fiddle-shaped bags are 
used as dilators. The middle is grasped and held by the os so 
that they cannot slip either way. Their introduction is effected 
by means of the cup shaped pouch in which the sound is inserted. 
First, empty out the air and turn the cock ; then fold the bag 
in itself, and pass it within the os. The nozzle of a syringe filled 
with water is adapted to the tube, and the fluid cautiously injected. 
After moderate dilatation the cock is closed and the bag left in 
place. Subsequent dilatation should be gradual, and is an imita- 
tion of the effect of the liquor amnii in the membranes. Larger 
bags may be subsequently used, or two inserted at once. 

Galvanism is uncertain, and its use has been abandoned. 

PROF. KARL SCHROEDER, M. D., ERLANGEN, 

Thinks Krause's method, the introduction of an elastic catheter, is 
preferable. This is explained above. Generally this suffices, and 
labor sets in. Should delay occur, Cohen's method of injections 
between the ovum and uterus may be used. A catheter is passed 
well up, and tepid water injected till tension is felt. The mem- 
branes are thus detached, and uterine action is roused. But this is 
more inconvenient and very dangerous. 



ABORTION AND PREMATURE LABOR. 2O9 

Tarnier's method by the " intra-uterine dilator " can never 
supersede the simple catheter. It is inconvenient, and not appli- 
cable for general practice. 

Mechanical dilatation is recommended by Brunninghausen, 
Kluge, and Barnes. These dilators are difficult to introduce, 
and are of no advantage. Those of Barnes require a previous 
dilatation permeable by two fingers. 

Plugging the vagina as by Scholler, Huter, and Braun : the 
colpeurynter is slow and uncertain, inconvenient, and causes great 
pain. It may be useful where there is hemorrhage, or when the 
pains cease, to provoke them, or where there is also required a 
counter-pressure against the membranes which are about to burst. 
This the colpeurynter is sure to prevent. 

Kiwjsch's ascending douche, at 30-3 5 ° R. against the os for 
10-15 minutes, is not reliable, nor free from danger, but may- 
favor dilatation of a closed cervix, and prepare for the use of other 
means. 

Puncture of the membranes, as by Scheel, Hopkins, and 1 
Meissner, is followed more slowly by the desired effect. Rokitan- 
sky, Jr., very highly recommends it. He considers that it gives 
better results to mother and child than any other method. Meiss- 
ner used a long, curved trocar, to puncture the membranes high. 
up. This is difficult, and now abandoned. 

ALFRED MEADOWS, M. D., LONDON. 

Adopts in preference the following plan. He secures free evacua- 
tion of the bowels, then introduces a sea-tangle tent, the size of a 
No. 7 catheter. The os is thus dilated so as to admit a small sized 
rubber bag; in five or six hours this may be withdrawn and a 
larger one introduced, and so on till action is induced. Or an 
elastic bougie is passed into the uterus, so as not to rupture the 
membranes. The cervix is now generally the size of a five-shil- 
ling piece. Uterine action is set up, and goes on more or less, 
speedily. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

Considers it always an advantage to allow the pains to come 
gradually, in imitation of natural labor; therefore, if after the bou- 
gie has been inserted, contraction come on strongly, the case mav 
be left to nature. If feeble, resort to dilatation by means of the 
fluid bags, and subsequently puncture the membranes. In this 
14 



210 DISORDERS OF PREGNANCY. 

way, the labor is completely under control, and he believes this 
method will commend itself as the simplest and most certain 
mode yet known, and most closely imitating the natural process. 

PROF. FLEETWOOD CHURCHILL, M. D., DUBLIN. 

Abdominal frictions and manipulations with warm baths, etc., 
rarely succeed. This author thinks the plan of Kiwisch admira- 
ble. This is the throwing a stream of warm water upon the os by 
means of a long tube. It rarely fails, and may be used for ten or 
fifteen minutes once or twice a day. The profession is now in 
possession of sufficient experience to pronounce favorably of this 
plan ; and it will probably supersede all others. 

The application of belladonna to the os uteri is doubtful and 
dangerous. 

Galvanism has been successfully employed by a number of prac- 
titioners. 

CHARLES CLAY, M. D., LONDON. 

This author, like many others, has no confidence in emmena- 
gogues, as they constantly fail, even when pushed to an enormous 
extent. The only certain means is the destruction of the vitality 
of the embryo, as it then becomes a foreign body. This is best 
effected by the use of the male catheter ; the escape of waters 
down the tube, with a tinge of blood, is evidence of success. 

TYLER SMITH M. D., LONDON, 

Regards Kiwisch's water douche superior to all methods. The 
stream may be of hot and cold water alternately, and by means of 
the patent syringe. 

PROFESSOR SCANZONI, GERMANY, 

Proposes to excite the womb by reflex action, by sucking and 
rubbing the breasts; these failing, he says Scheel's mode of per- 
forating the membranes is the most sure and rarely fails, but is 
objectionable because of the delay and the risk to the child, etc. 

He alludes to the gradual dilatation of the neck by sponge 
tents and tampons in the vagina as inconvenient, painful and other- 
wise objectionable. 

He says in review, the uterine douche of Kiwisch is preferable 
when prompt action is not obligatory because of hemorrhage, and 
the membranes can readily be perforated if danger is imminent, and 



ABORTION AND PREMATURE LABOR. 211 

thus the volume of the womb may be rapidly diminished. The 
injections into the cavity of the uterus by Cohen's method are dif- 
ficult, especially in the primipara, where the neck is closed or dis- 
placed ; and dangerous at least to the child because of the liability 
to penetrate the membranes. 

PROF. S. TARNIER, PARIS, 

Prefers the separation of the membranes when the internal orifice 
is open ; dilatation of the neck when the orifice will not admit of 
the passage of instruments to separate the membranes. A last 
resource will be the excitation of reflex action. 

RESUME OF REMEDIES. 

I. UTERINE SEDATIVES AND TONICS. 

Arsenic has been recommended in threatened abortion from irritable 
uterus, by Mr. Henry Hunt, of Dartmouth, England. 

Cannabis Indica has been found useful in impending abortion from con- 
gestion or irritability of the uterus. From v-xx drops of the 
tincture may be given every two or four hours. Drs. Clenden- 
ning, Reynolds, Lever and Churchill praise its effects. 

Ergota is constantly employed in accidental abortion. See (p. 201.) 

Opium is one of the most important agents of this class. (See p. 202.) 

Plumbi Acetas is a valuable adjunct to opium in uterine hemorrhage with 
threatened abortion. 

Quinine is thought by many to act as a uterine stimulant, and to be ad- 
vantageous in this accident. 

Sabina is useful against the hemorrhage which indicates approaching 
abortion in women of bad fibre. In these cases, the dried 
powder of the leaves may be given, in doses of gr. xv-xx 
thrice daily. In habitual abortion depending upon diminished 
vitality of the uterine system, savin has also been advised : 

235. f£. Sabinae, 5ij-iv 

Aquae ferventis, f-Ivj. M. 

A tablespoonful thrice daily, taken during the intervals of the 
menstrual period. This remedy must, however, be employed 
with caution. 

Tannicum Acidiun, in combination with opium and ipecacuanha, has 
been strongly advised in threatened abortion. 

TerebinthiiMB Oleum has been favorably reported upon by Dr. Fordyce 
Barker in the treatment of abortion; given as an enema, he 
found it act as an effective oxytocic, as well as hemostatic. 

Viburnum Prunifoiium is an extremely valuable preventive of abortion, 
often succeeding where other means fail. The bark of the root 
is the portion used, from which an extract is prepared. It has 



212 DISORDERS OF PREGNANCY. 

been especially noticed by Dr. E W. Jenks. {Gynecological 
Transactions, 1876.) 
Emetics. Dr. J. G. Stokes, of Illinois, (Half-Yearly Compendium, Vol. 
VIII.,) advocates the use of emetics in all cases of abortion, es- 
pecially in those continued cases of threatened abortion which 
are so annoying to both physician and patient. 

2. ECBOLTC OR ABORTIFACIENT AGENTS, OR UTERINE EXONERANTS. 

Aloes. Most of the patent pills sold for the real if not avowed object 
of inducing abortion are composed of aloes combined with 
drastic cathartics, the effect of the violent peristalsis induced 
being to excite by sympathy uterine contractions. It is needless 
to add that this plan is both unscientific and dangerous. 

Cantharides sometimes produces abortion through the renal and vesical 
excitement which it causes. As a medical means to this end, it 
is too dangerous. 

Ergota. Probably the most efficient of known ecbolics continues to be- 
the various species of ergot, as derived from rye, wheat, rice, 
or maize. It has, however, been denied that it acts as such, ex- 
cept in the uterus at term. The eminent Dr. Paul Dubois 
denied that it could provoke abortion. The correct opinion 
seems that advocated by Fonssagrives (Th'crapeutique, 1878), 
that its ecobolic action is null at the commencement of 
pregnancy, but increases in direct proportion as the latter 
progresses. 

Gossypium. The fresh bark of the root of the cotton plant, in decoction 
(liv of the root to water Oij, boiled to Oj), in doses of f.^iij 
repeated, is a popular abortifacient in the southern States. The 
fluid extracts on sale are generally almost or quite inert. 

Jaborandi and Pilocarpin. Considerable attention has been directed to 
these agents as ecbolics, and they have recently been carefully 
studied by Prof. P. Muller, of Berne. He justly remarks 
that it certainly would be a great advantage if premature 
labor could be induced by internal remedies. All the dan- 
gers from traumatism and infection would be absent, and the 
objections which now exist against ergot might be found want- 
ing in the new agent. But his experiments were not encourag- 
ing. To test the contraction-exciting power of pilocarpin, 
Muller gave it to puerperal women, whose uteri are particu- 
larly susceptible to such excitants. Multiparas with flaccid 
abdominal parietes and large, readily palpable uteri were 
chosen, and both ergotin and pilocarpin given them. ' The 
results showed that pilocarpin does not act as powerfully as 
ergot, for if the observations are continued through several 
days, after two days the pilocarpin loses its effect. 

Quinio? Sulphas. From a mass of evidence laid before the American 
profession, of recent years, there would seem to be no doubt 
but that, under some circumstances not yet ascertained, quinine 
provokes abortion. This would appear to be more especially 
the case when administered in large doses in the absence of 
malarial poisoning in the system. 



ABORTION AND PREMATURE LABOR. 2 I 3 

Ruta. The rue is one of the oldest known abortives. Its specific action 
as such, and independent of any intestinal irritation, has been 
abundantly established by the recent researches of Dr. E. Ham- 
elin {Diet des Sciences Med., 1877). Although uncertain in 
its action, he thinks the uterine contractions to which it gives 
rise are more physiological in character than those following 
the use of ergot. In administering it, he prefers an infusion of 
the fresh leaves and roots to any other form (3ij-iv to water Oj), 
to be taken in two or three duses at intervals. 

Sabina. The reputation of this plant as an ecbolic is probably not just- 
ified. Dr. E. Hamelin, who has studied its properties care- 
fully, doubts whether it excites directly any uterine action ; if 
such follows, it is the result of transmitted irritation. 

Sodii Boras. The use of boras as an ecbolic is of doubtful efficacy. 

Tanacetum, often used for criminal purposes as an abortifacient, is, in 
the opinion of Stille, incapable of producing any such result. 



VOMITING AND NAUSEA OF PREGNANCY. 

PROF. G. TARNIER, PARIS. 

In slight vomitings, some aromatic infusion or tea will generally 
relieve. When they occur after a daily meal, it is useful to change 
the order of the repast. Thus if, as is usual, the vomiting is very 
copious after the evening meal, the woman should make merely a 
light repast, and eat more at breakfast. Cold food is least likely 
to be ejected. Ices, aerated waters, or small pieces of ice may be 
taken with the best results. The subacetate of bismuth, in doses 
of a grain or half a grain before each meal, is very beneficial ; or 
after the meal, two or three teaspoonfuls of Kirsch. In obstinate 
cases, a pill, or two or three centigrams of aqueous extract of 
opium, may be given an hour before the meal, and to prevent onc- 
stipation, a slight purgative occasionally. Where the vomiting is 
accompanied with pain and tension at the epigastrium, lotions of 
laudanum are useful ; or a small blister, subsequently powdered 
with one or two centigrams of the muriate or acetate of morphia. 
Dezon has succeeded by the application of cold water to the epi- 
gastrium. Alcohol to a slight intoxication has proved success- 
ful ; hence champagne frequently at once gives relief. Breton- 
neau has calmed the irritability in grave cases by frictions on the 
stomach with a concentrated solution of belladonna. Tarnier 
applied this in a very bad case in the form of the extract to the in- 
ferior segment of the uterine neck and the vaginal walls with the 
best results. 

Stackler has succeeded with the black oxide of mercury, 5 
centigrams daily, without salivation. Eulenberg applied tincture 
of iodine to the os. Ricord and Bacarisse also gave 50 centi- 
grams of iodide of potassium daily, and with equal success. The 
salts of cerium, particularly the oxalate, are extremely useful in 
doses of 5 centigrams, 3 or 4 times a day. 

Obstinate constipation generally is present with the vomiting. 
Here he gives scammony, 50 centigrams, with one grain of jalap 
at bed-time. If the first is vomited, repeat it immediately, and 
even a third dose. Generally the second or third will be retained 
and act purgatively. When an examination reveals a retroversion 

(214) 



VOMITING AND NAUSEA OF PREGNANCY. 2 I 5 

of the uterus, generally its replacement will at once put an end to 
the vomitings. 

In cases likely to prove fatal, especially when the pregnancy has 
advanced to a point that assumes the vitality of the child, prema- 
ture labor may be deemed necessary. 

PROF. KARL SCHROEDER, OF ERLANGEN. 

This author suggests subcutaneous injections of morphia. Pip- 
PINSKOLD has cured it with enemata of broth, oil, and wine. If 
the child be viable, labor must be induced. It must not be for- 
gotten that it may be due to a round ulcer of the stomach. 

WM. LEISHMAN, M. D. LONDON. 

Breakfasting in bed and not rising for awhile often speedily 
relieves the trouble. In cases where the bowels are sluggish, the 
granular effervescing citrate of magnesia is useful, or the " potion 
de Riviere " given so that the effervescence occurs within the 
stomach : 

236. ^. Acid, citric, gr. xxxvj 

Syr., simp., f.^i 

Aquas, f.§ij. M. 

237. I£. Potassii bicarb, gr. xxxvj 

Aquae, f.giij. M. 

A tablespoonful of each to be taken successively. When there is ex- 
haustion, stimulants are required. Pepsin is valuable. Often simple 
milk, and lime-water, and barley water (especially the latter), are 
retained in very grave cases. Nutritive enemata may be employed 
to sustain the failing powers or inunctions of cod or other oils. 

DR. ALBERT EULENBERG, BERLIN. 

238. ^. Tincturae iodinii, n\xv 

Alcoholis, f.§iij. M. 

Give three drops several times a day, in a tablespoonful of an aro- 
matic infusion. 

239. fy. Tincturae iodinii, gttx 

Aquae destillatae, f . § i ij 

Syrupi aurantii corticis, f.^j. M. 

A teaspoonful, or even a tablespoonful. 

Other approved prescriptions are : 

240. I£. Bismuthi subnitratis, 3iij 

Acidi carbolici, g r -i v 

Mucilaginis acaciae, f.^j 

Aquae menthae pipentae, f-liij- M. 

A tablespoonful three or four times a day. 



2l6 DISORDERS OF PREGNANCY. 

241. I£. Atropiae sulphatis, gr.ij 

Aquae destillatae, f.gj. M. 

Two drops in water, before meals. 

242. I£. Cerii oxalatis, gr.x 

Bismuthi subnitratis, gr.xxx. M. 

Make ten powders. One five or six times a day. 

Sometimes a rectal injection of chloral hydrate, gr.xxx, morning 
and evening, will effectually control this symptom. Bromide of 
potassium, S], thrice daily; chloroform, gtt.ij, in mucilage, and 
medicated pessaries, may also be tried. Dr. E. Copeman, of Nor- 
wich, Eng., claims invariable success to follow dilatation of the os 
uteri with the finger, once often being sufficient to relieve the 
nausea completely. (British Medical Journal, May 25, 1875.) A 
somewhat similar plan is that suggested by Dr. M. O. Jones, of 
Chicago, to wit : Painting the os and cervix with tincture of 
iodine, or cauterizing them with solid nitrate of silver. This plan 
has met with great success in obstinate cases, and has been en- 
dorsed by Dr. J. Marion Sims. 

W. STUMP FORWOOD, M. D., OF DARLINGTON, MD. 

This practitioner recommends the following as almost a specific 
in the vomiting of pregnancy (Half Yearly Compendium, Vol. III., 
p. 96) : 

243. I£. Columbae, fss 

Sennae, 5j 

Zingiberis, fss 

Aquae bull., Oj. M. 

A wine glass full three times a day. 

HENRY F. CAMPBELL, M. D., OF AUGUSTA, GA., 

Has called attention to the importance of rectal alimentation in the 
nausea and vomiting of pregnancy, not merely as a last resort, but 
as an expedient for supplementing inadequate nutrition by the 
stomach in moderately severe cases (Trans. Am. Gyn. Soc, 1878). 
He uses about eight ounces of beef tea, or other nutrient liquid, 
twice daily, injecting it very slowly and gently, so as to avoid 
exciting the lower bowel to expulsive efforts. To supply fluids, 
during the intervals of the morning and evening injections, a full 
goblet of water, not quite cold, was twice given some hours apart. 
The results in the instances reported were highly satisfactory, the 
nutrition being maintained, the nausea abated, and the sympathetic 
irritation of the stomach relieved. 



VOMITING AND NAUSEA OF PREGNANCY'. 2 1/ 

RESUME OF REMEDIES. 

INTERNAL REM EDI ES. 

Acidum Hydrocyanicum Di latum, gtt. v., is a valuable sedative. 
Aconitum. A few drops of the tincture of aconite will relieve some cases. 
Armor acia. Dr. Tilt recommends a small portion of horse radish, 

scraped fine, and moistened with vinegar. 
Arsenicum. Single-drop doses of Fowler's solution will sometimes afford 

astonishing relief. 
Atropia has been used with advantage (F. 241) Wm. Boys, M. D., 

Waverly, Iowa, in the Med. Brief, Oct. 1879, gi ves tne 

following : 

244. B- 



Dose, gtt. 



Atropiae sulph., 
Morph. sulph., 
Ac. sulph. arom., 
Aquae, 


gr.j 
gr. iv 
f.3iij 
f.3v. 


x-xx 3 times a day. 





M. 



Belladomia, in ten minim doses of the tincture, is recommended by Tilt 

and others. 
Bismutlu Subnitras will be found at times an efficient sedative (F. 240). 
Calumba, according to Phillips and Bartholow, will frequently allay the 

nausea and vomiting. 
Carbolicum Acidum, in drop doses of the crystallized acid, in mucilage, 

thrice daily, has been recommended by English writers. 
Cerii Oxalas has attained great favor. Dr. F. E. Image {Practitioner, 

June, 1878,) prefers this formula: 

245. I£. Cerii oxalatis, 

Pulv. trag. co., aa gr. x 

Tinct. aurant, f.3ss 

Aquam, ad f.§j. M. 

For one dose as required. It is often given in too small a dose ; 
gr. x is required. 

The nitrate of cerium has also been used. 
Chloral Hydras, in simple nervous erethisms of the stomach, often acts 

promptly; gr.xxx in mucilage for a rectal injection is the best 

form of administration. 
Chloroformum may be given in doses of a few drops in a spoonful of 

milk. Sir C. Locock recommended repeated chloroformization 

almost to insensibility. 
Creasotum should, according to Dr. Ringer, be given in very small 

doses, for instance, added to water just so that the latter tastes 

of it, and then a dessertspoonful of the fluid taken from time to 

time. 
Cupri Sulphas, gr.iv to aquae f.fj. Six drops at a dose will sometimes 

relieve. (Bartholow.) 



2l8 DISORDERS OF PREGNANCY. 

Ether. A few drops at a time in water, or inhaled, will at times relieve 
the nausea. The spine has also been sprayed with 'the ether 
spray with most excellent results, by Dr. Dubelski, of Warsaw. 

Hydrargyrum Chloridum Mite. Dr. Tilt occasionally administers gr.x- 
xv of calomel for its sedative action; or combines it in smaller 
quantities with opium. 

Hyoscyamus. *Dr. Pitois, Professor at the Medical school at Rennes, re- 
ports two striking cases of relief by hyoscyamia. After trying, 
unsuccessfully, all the usual means, he administered a teaspoon - 
ful every hour of a mixture containing five milligrammes of hy- 
oscyamia in 125 grammes of fluid. The next day the vomiting 
ceased. 

Ingluvin. This substance, used to facilitate digestion, has been favorably 
reported upon. 

lodinium, in drop doses of the tincture every hour or two, will, according 
to Bartholow, sometimes greatly relieve this symptom. 

Ipecacuanha. Dr. C. Fuller {Lancet, Dec. 4, 1869,) introduced the 
treatment of vomiting of pregnancy by single drop doses of wine 
of ipecac, in a teaspoon ful of water every hour. Others have 
also reported favorable results from this plan. 

Lactopeptin. This peptic compound has in a number of instances relieved 
the nausea and vomiting. 

Magnesia in small quantities occasionally affords relief. 

Nux Vomica, in tincture, gtt.v-x, as required, is relied upon by Playfair 
and others. Bartholow says it is best adapted to cases with 
much nausea and little vomiting, in doses of half a drop to a 
drop. 

Opium and Morphia are, according to Tilt, the first remedies to be 
tried. He recommends suppositories containing gr. ij-iij of 
extract of opium, or gr.j morphise acetatis ; or the drug may be 
given by the mouth. Inquiry, however, must be made as to the 
idiosyncrasy, as it is well known that any form of opium 
produces vomiting in some persons. Dr. Atthill combines 
morphia with atropia for a hypodermic injection : 

246. !£.. Morphias acetatis, gr.viij 

Atropia? liquoris (B. Ph.), irtxlviij 

Glycerinas, ■■ THY 

Aquam, ad f.5iv. M. 

Dose. — Five to ten drops for a hypodermic injection. 

Pepsina, either as wine or in other forms, will often succeed. 

Potassii Bromidum. Dr. S. C. Busey, Washington, D. C. (Amer. Jour. 
Med. Sci. y January, 1878), has obtained decided and immediate 
relief from the bromide of potassium. He gives 30 grains to a 
drachm, dissolved in beef-tea, to which brandy and laudanum 
may be added, according to the condition of the patient. He 
gives it in enemata every four hours, 

Potassii lodidum is occasionally of service. 



VOMITING AND NAUSEA OF PREGNANCY. 2IO, 

Salic in has been occasionally found to be of service. 
Strychnia. Dr. Tilt strongly recommends : 



247- R. 



Dose 



Strychniae, 












gr.X 


Tinct. zingi 


be 


ris, 








f.Svj 


Aquae, 












f.Biv. 


tea spoonful 


ev 


ery 


one 


or 


two hours 





M. 



Tannicum A'cidum, in the form of a pill, gr i-ij, morning and evening, 
has been found very successful by Dr. Diboue {Arch, de Tocolo- 
gie, Sept, 1877). 

Stimulants. Recourse must be had to these cautiously, on account of the 
relief they sometimes give leading to the habit of tippling. 
When accessible, the best is probably dry champagne, iced, of 
which tablespoonful doses may be given every 15 minutes. 

LOCAL MEASURES. 

Caustics. Dr. J. Marion Sims believes that the treatment should always 
be directed to the seat of the irritation, and claims the best re- 
sults from the use of caustic to the os ; two or three applications 
generally suffice. This method he employs even when there is 
no sign of erosion of the mucous lining of the os, and the parts 
appear perfectly healthy. Dr. F. D. Lente {Med. Record, 
1879), agrees with Dr. Sims, and freely touches the os and cer- 
vix with the nitrate of silver. He quotes Dr. M. O. Jones, 
Chicago, as using this method with the best possible result, and 
where, in the majority of cases, the os presented no signs of 
disease. Dr. Playfair considers the measure hazardous. 

Cold, applied to the epigastrium, or by swallowing pieces of ice, is often 
beneficial. 

Electricity. Dr T. Gaillard Thomas, of New York, employs elec- 
tricity. He fixes one broad flat electrode, made by stitching a 
flat sponge to sheet rubber, by means of adhesive plaster on the 
epigastrium, and a similar one under the spine, the patient ly- 
ing supine. Then a gentle current is passed, and continued 
steadily for 10, 12, or even 24 hours. He has seen no evil 
result, and esteems this remedy higher than any other. 

Dr. da Venezia relates in the Giornale Veneto di Scienze 
Med. (January, 1879), a case °f chronic nervous vomiting in 
pregnancy which was cured by electricity. The patient was a 
young woman aged 24, in the seventh month of her first preg- 
nancy. She had been suffering for the last two years from fre- 
quent attacks of vomiting after food, which had been so fre- 
quent during the last month, that she had become greatly re- 
duced in strength. The usual therapeutic agents were then 
employed; but, as no relief was obtained through them, the 
author resolved to try electricity. A faradic current of mod- 
erate strength was used, one of the rheophores being applied to 
the side of the neck along the course of the vagus neive, and 
the other to the epigastrium. After the first sitting the patient 
was better, and after the fourth the vomiting ceased. 



220 DISORDERS OF PREGNANCY. 

Heat. Tanner mentions hot fomentations to the epigastrium and hot 
poultices, as occasionally useful. 

Injections, either rectal or vaginal, are efficient means. Those containing 
opium are most useful. In the Boston Medical and Surgical 
Journal, 1879, Dr. Greene, of Dorchester, advocated the use 
of warm vaginal lavements for many cases of obstinate vomiting 
of pregnancy. He also reports a case where warm olive oil 
succeeded after the water had failed. • 

Leeches to the os have been used by Clay, but their propriety has been 
doubted by Playfair. Dr. Tilt mentions that in some cases 
the vomiting has been promptly checked, after the failure of 
ordinary measures, by the application of a few leeches to the 
pit of the stomach, although there were no signs of inflamma- 
tion there, and the patient was not plethoric. 

Suppositories, both rectal and vaginal, containing opium or its alkaloids, 
are among the earliest resources indicated. As a medicated 
pessary, Dr. Tanner prescribes : 

248. fy. Extracti belladonnas, gr.xxv 

Extractihyoscyami, gr.lxxx 

Plumbi iodidi, 5j 

Theobromoe cocose, ^j 

Olei olivae, f.3ij- M - 

For eight pessaries. One to be introduced into the vagina 
every night. 

The author has in many extremely obstinate cases obtained the 
most prompt benefit from the employment of suppositories of bel- 
ladonna and hyoscyamus. 



SYMPATHETIC NERVOUS DISORDERS. 

These are palpitation of the heart, headache, syncope, cough, 
neuralgia, pruritus, hypochondriasis. 

PROF. W. S. PLAYFATR, M. D. LONDON, 

For the palpitation, would give ferruginous preparations, and a 
general tonic regimen. When it does not seem to result from 
debility, antispasmodics are indicated. 

Syncope occurs generally in women of a highly-developed nerv- 
ous temperament, and generally about the time of quickening. 
The treatment should consist in the use of diffusible stimulants, as 
ether, ammonia, and valerian, the patient being recumbent with 
the head low. In the intervals, tonics and iron are necessary. 

Neuralgia is generally controlled by tolerably large doses of 
quinine. If caries of the teeth is present, the affected tooth should 
be removed without fear. Nitrous oxide gas maybe administered 
without difficulty or risk. 

ELY VAN DE WARKER, M. D., OF NEW YORK. 

This writer extols the black cohosh, cimicifuga racemosa, for the 
nervous disorders of pregnancy {Half Yearly Compendium, Vol. 
XIII., p. 176). He says: 

"Women are oftentimes the subjects of distressing symptoms as 
pregnancy advances. Among these are a train of nervous symp- 
toms : Restlessness, sleeplessness, darting pains in the back, flanks 
and thighs, and stiffness and soreness in movement, are very 
common and troublesome. For these conditions I find black 
cohosh, cimicifuga racemosa, a sovereign remedy. I give thirty 
minims, or 'half a teaspoonful, of the fluid extract at bed time, in 
cases of restlessness ; and in cases of neuralgia of the lumbar or 
abdominal muscles, or in cases of stiffness or soreness in move- 
ment, the extract may be given in the same amount, at intervals 
of three to five hours during the day. 

THOMAS H. TANNER, M. D., LONDON. 

The headaches of pregnancy are usually due either to debility 
or to sympathy. The first is dull and steady, the skin cool, and 

(221) 



222 DISORDERS OF PREGNANCY. 

the pulse feeble. Its successful management demands quinine and 
iron, good diet, exercise, and general hygiene. The sympathetic 
headache is generally limited to a small space, or a single spot. 
The pain is acute and penetrating. The treatment is a moderate 
purgative followed by tonics. The extract of aconite, gr.j4, every 
four or six hours, sometimes gives prompt relief in such cases. 

In puerperal cases, insomnia is not unfrequently the precursor of 
delirium or mania. It demands, therefore, careful attention, and, 
if persistent, the cautious use of hypnotics. 

Groundless despondency, hypochondriasis, is not very unusual 
during the period of gestation. The bowels should be acted on 
with rhubarb and soda, pepsin taken after the meals, and a tonic, 
such as the following, be prescribed : 

249. I£. Spiritus ammonise aromat., f.5iij 

Spiritus chloroformi, f.3ij 

Ferri et quinice citratis, gr.xxx 

Liquons strychnia?, TTJxxx 

Tincturse zingiberis, f.3ij 

Aquam, ad f.gviij. M. 

A sixth part two or three times a day. 

Sometimes the union of the tonic with an alterative is desirable, 
as : 

250. fy. Ammonii muriatis, gr.lx 

Extracti cinchonas liquoris, irtxc 

Vini rhei, f.5vj 

Aquam menth. piper., ad f.fviij. M. 

A sixth part twice daily. 

The moral management of such cases is also important. Posi- 
tive assurances of the future must be given; the demeanor must 
be humane and sympathizing; and she must be guarded from 
scenes and tales of suffering. 

Pregnant women toward the eighth month are sometimes subject 
to sudden attacks of intensely acute pain in the right side. The 
treatment should be to make the patient lie on her left side, cover 
the region of the pain with hot fomentations containing belladonna 
and opium, and administer a full dose of an anodyne and carmina- 
tive mixture. As long as any pain remains, she should keep her 
bed, and lie on the left side. 

The sympathetic nervous cough of pregnancy comes on in violent 
paroxysms, especially at night, without expectoration or steth- 



SYMPATHETIC NERVOUS DISORDERS. 223 

oscopic signs. In its treatment, he has found antispasmodic 
mixtures like the following to give great relief: 

251. I£. Spiritus etheris, f.5iij 

Tinct. chloroformi comp, f.3j 

Acidi hydrocyanici diluri, v\ xv 

Liquoris morphias sulphatis, f.3i 

Tinct. cardamomi comp, f-5vj 

Aquam, ad f.sviij. 
A sixth part every 6 or 8 hours. 

Or, 

252. I£. Tinct. Valerianae amnion., n\xxx 

Tinct. sumbulis, tt^xx 

Tinct. belladonnas, v\x 

Tinct. camph. comp., ^ixxx 

Aquam camphorae, ad f.3xij M. 

For one dose. 

Efforts must be continued to check the cough when violent, as 
its continuance sometimes leads to abortion. 

TYLER SMITH, M. D., LONDON, 

Regards pruritus as the result of follicular irritation of the vulva. 
The secretion from the surface is generally very acid, which may 
be relieved by washing with common yellow soap. Dilute hydro- 
cyanic acid, Battley's solution, of each f.5ij, and carbonate of soda, 
5ij,. water f.Syj, make an excellent wash, using only a tablespoon- 
ful at a time. A lotion of borax is good; sometimes an acidulated 
lotion is preferable, or a lotion of tar water. In obstinate cases, 
paint the vulva with nitrate of silver, 10 grains to water one ounce 
every day, or every other day ; or with tincture of iodine with an 
equal part of water. Where the os uteri is thus troubled, inject the 
lotion of borax or nitrate of silver. Tepid or cold bathing, cooling 
diet, and aperients, are also aids in the cure. Should it assume 
a periodic form, quinine is the remedy. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

Pruritus is frequently associated with leucorrhea of an acrid 
nature; or there maybe aphthous patches on the mucous mem- 
brane, ascarides in the rectum, or pediculi in the hairs of the mons 
and labia. Sedative lotions are useful, as Goulard's, or an ounce 
of the solution of muriate of morphia with a drachm and a half of 
hydrocyanic acid in six ounces of water; or chloroform, one part to 



224 DISORDERS OF PREGNANCY. 

six of almond oil. A pledget of cotton- wool soaked in equal parts 
of glycerine of borax and sulphurous acid, may be placed in the 
vagina at bed-time, and removed in the morning. In obstinate 
cases, the solid nitrate of silver may be brushed lightly over the 
vulva. Generally the aperient mineral waters and bromide of 
potassium aid in the cure. 

PROF. S. TARNIER, PARIS, 

Gives this formula : 
253. S- 



Deutochloride of mercury, 


2 grams 


Alcohol, 


10 " 


Rose water, 


40 " 


Distilled water, 


450 " 



He employs this night and morning thus : Bathe the parts with 
warm water to remove any discharges, then, having carefully dried 
the surface, rapidly sponge the seat of the affection with the lotion. 
In a few minutes, wash again with fresh water. The^cure is gen- 
erally rapid. 

[For further suggestions regarding the Pruritus of Pregnancy, see Part I., 
Chap. III., under Pruritius of the Vulva. 



DIGESTIVE DERANGEMENTS OF PREGNANCY. 

GINGIVITIS, PUERPERAL SALIVATION. 

Dr. A. Pixard of the Clinique d' Accoiiclicmcnt, of Paris (/,' 
Abeille Med. Jan., 1878), remarks that in many cases of pregnancy, 
the gums are the seat of more or less morbid phenomena. They 
are redder and more congested than normally ; they are swollen ; 
the edge of the free border, especially the inter-dental membrane, 
covers a part of each tooth. The slightest pressure exerted on 
this edge, causes a slight hemorrhage. At a more advanced de- 
gree, the teeth lose their solidity. The mastication, at first injured, 
becomes more painful and more difficult as the lesions are more 
pronounced. 

For the relief of this condition, he has used : 

254. ]£. Chloral hydratis, 

Tinct. cochlearias off., aa partes equales. 

Apply daily, or every other day, to the diseased edge of the gums, 
with a mop. 

This dressing is slightly painful, and the cauterization very light. 
The eschar disappears generally twenty-four or thirty-six hours 
after the application. In thirty women attacked with gingivitis, 
who were subjected to this treatment, twenty-five were cured in 
less than fifteen days. In two of them the cure was slower, com- 
plications having supervened which necessitated the use of mercu- 
rial ointment. In five others the treatment could not be continued. 

Dr. Thomas H. Tanner remarks that some writers say the sali- 
vation should not be checked ; but he distrusts this view. He has 
found small blisters behind the ears or to the neck more efficient 
than any other remedy. Local remedies are seldom of use ; one 
of the best is 

255. I^. Sodii boracis glycerini, f.^ij 

Aquae rosae, . f-B v j- M- 

For a gargle. To be used twice daily. 

Belladonna is the only internal remedy he has seen diminish the 
discharge, but this often fails. Chlorate of potassa may be tried. 
15 ( 22 5) 



226 DISORDERS OF PREGNANCY. 

DIARRHOEA 
Occasionally is present, and Playfatr regards it as due to errors 
of diet. It should not be neglected, as it may bring on labor pre- 
maturely. The chalk mixture, with aromatic confections and small 
doses of chlorodyne and laudanum, will generally check it. 

Leishman counsels the removal of any fecal accumulations by 
castor oil and then the use of astringents. 

CONSTIPATION. 

Leishman regards this as due to the pressure of the womb on 
the bowel, reducing its calibre and paralyzing its muscular fibres. 
In other cases, a want of bile occasions it. If clay-colored stools 
show this, a few grains of blue pill will do good. 

Playfair suggests appropriate diet, as fresh fruits, brown bread, 
oatmeal, etc. The aperient mineral waters answer well, and an 
occasional dose of confection of sulphur ; or a pill of three grains of 
extract of colocynth, quarter of a grain of extract of nux vomica, 
and a grain of extract of hyoscyamus at bed-time ; or a teaspoon- 
ful of compound liquorice powder at bedtime. This condition is 
effectually combated by giving, twice a day, a pill of two grains of 
inspissated ox-gall with a fourth of a grain of extract of bella- 
donna. Enemata of soap and water are good. Scybalse must be 
broken up and removed by mechanical means. 

Dr. W. Craig, Edinburgh (Edinburgh Med. Jour., June, 1875), 
has found the following an excellent pill for the constipation so 
common in females of a sedentary habit : 

256. ^. Aloin., gr.ss 

Ferri sulph. exsic, gr.iss 

Extract, nucis vomica?, gr.ss 

Extract, belladonnas, gr.ss. 

.Fiat pil. One or two pills daily. 

Another writer gives: 

.257. $. Ext. colocynth comp., gr.xij 

Pulv. rhei, g r - v j 

Ext. belladonnae, gr.iss 

" hyoscyami, g r -iij- M. 

/Divide into six pills. One at bed-time. -^ grain of strychnia may be 
added to each pill. 

HEMORRHOIDS. 
.Leishman says the treatment must be purely palliative. Spong- 
ing with water; fomenting with sponges wrung out of hot water, 



DIGESTIVE DERANGEMENTS OF PREGNANCV. 227 

and applied as hot as they can be borne; applications of ung. 
gallre cum opio ; and cold injections for hemorrhage. 

Cazeaux gives every night a cold enema; when this is evacua- 
ted, a second of about one-fourth the quantity, this to be retained. 

Playfair likes the sulphur electuary. When tender and swol- 
len, he covers the tumors with an ointment of four grains of muri- 
ate of morphia to an ounce of simple ointment. 

R. P. Harris, M. D., adds to the ung. gallse cum opio §j — ext. 
of stramonium 5j. The tumors should always be returned care- 
fully within the sphincter, and punctured if necessary to lessen the 
congestion, prior to the attempt at reduction. 

Tarnier relieves the constipation, then uses cataplasms and lo- 
tions, emollient and narcotic. When internal, introduce supposi- 
tories within the rectum. Opium and belladonna are most useful. 

During pregnancy and the puerperal period, hemorrhoids often 
occur. For them Dr. Barker recommends the following formula : 

258. #. Pulv. aloes soc. 

Sapo cast., aa 9j 

Ext. hyoscyami, 3ss 

Pulv. ipecac, gr.v M. 

Divide in pills No. xx. Sig. — One morning and evening. 

When the hemorrhoids are associated with an irritable rectum, 
and with frequent small, teasing, thin evacutions, he substitutes 
for the hyoscyamus a small quantity of opium, giving also a less 
quantity of aloes, as in the following formula: 

259. I£. Ferri sulph., E)j 

Pulv. aloes, gr.x 

Ext. opii aq., gr.x 

Sapo cast., gr.x. M. 

Ft pil. No. xx. Sig. - One morning and evening. 

Locally he applies the following ointment to the tumors and 
well up in the rectum twice daily : 

260. R. Ung gallae co., £j 

Ext. opii aq., 9j 

Sol. ferri subsulphatis., f.3j M. Ft. ung. 



ALBUMINURIA OF PREGNANCY. 

PROF. WM. LEISHMAN, M. D., GLASGOW, 

Says antfphlogistics must only be used with the greatest caution. 
Baths are useful by promoting the function of the skin. Diuretics 
are of doubtful value. 

Dr. J. S. Parry, the Philadelphia editor, urges the following : 

261. IL Tr. ferri chlo., f.5iij 

Liq. ammon acet, f.§iij 

Ac. acetic, "nixv 

01. gaultheriae, gtt.v 

Syr. aurant. cort, f.§j. M. 

Dose. — One to two drachms three times a day. 

It is of great importance to recognize the presence of albumen 
early. Such symptoms as edema, even of the minor form, should 
always prompt the physician to test the urine for albumen. It 
may, indeed, exist, and apparently in no way affect the general 
health. When this is the case, active medication is needless. It 
will be enough to regulate carefully the diet, and maintain in nor- 
mal action the secretory functions. Cases which are wholly due 
to the pressure of the enlarged uterus and its contents, often con- 
tinue to the close of the pregnancy and pass through confinement 
without any untoward accident. The avoidance of interference 
therefore, and a watchful supervision of the case, embrace all that 
the physician is called upon to do. It must be borne in mind 
that the disease is one of debility, and implies impoverishment of 
the blood, so that lowering treatment is usually out of place, and 
tonics and a generous diet are rather called for. Occasionally 
some of the mildest diuretics may be exhibited, but, as above men- 
tioned, their general use is of questionable propriety. 

PROF. W. S. PLAYFAIR, M. D., LONDON, 

Saline diuretics, as acetate or bitartrate of potassa, and watery 
purgatives, as the compound jalap powder, are most useful in pro- 
moting the urinary secretion and relieving the renal congestion. 
Dry cupping over the loins, frequently repeated, and the vapor or 
Turkish bath, will aid greatly. The diet should be mainly of milk 

(228) 



ALBUMINURIA OF PREGNANCY. 220, 

and white of egg, and a little white-fish. The tincture of perchlor- 
ide of iron, with the tincture of digitalis, acts well. The induction 
of labor must depend upon the gravity of the symptoms. 

TYLER SMITH, M. D., LONDON, 

Believes in small bleedings where there is distinct lumbar pain 
and general febrile excitement, or cups to the loins, or sinapisms. 
Warm and vapor baths, aided by diuretics, as acetate of potassa, 
oil of juniper, infusion of broom, will tend to remove the effusion, 
and cause the kidneys to act. Then tonics, iron, and good diet. 
Wheie the phosphatic diathesis exists, we require the mineral 
acids, opium, and rest. 

s 

PROF. S. TARNIER, PARIS * 

At the Maternite, has for some years treated albuminuria entirely 
by milk, and with most excellent results. One litre (jj^ pints) of 
milk, increased to three and four litres a day, are given, and the 
albuminuria rapidly diminishes or disappears. The effect is shown 
in a week or a fortnight. 

PROF. MONTROSE A. PALLEN, M. D., NEW YORK, 

Regards as the correct treatment the relief of the hyperemia of 
the kidney by sponging the surface with hot water and alcohol and 
by keeping the pores open with vaseline inunctions ; to this may 
be added the hot air or Turkish bath ; milk is given as the most 
digestible food; kumyss was added because of the very slight 
amount of, and easily digested alcohol in it. The patient is to 
be kept in bed, to maintain the skin at a uniform temperature ; 
massage stimulates the circulation, and equalizes the blood cur- 
rent ; cathartic water is the best aperient. If eclampsia is threat- 
ened, have recourse to chloroform, and bleeding. 

PROF. EDW. S. DUNSTER, M. D., ANN ARBOR, MICH. 

In treating of the prophylaxis of puerperal convulsions, this au- 
thor suggests in albuminuria, the relief of the congestion of the 
kidneys by causing the skin to act ; he gives bitartrate of potassa, 
compound jalap powder, citrate of magnesia, and sulphate of mag- 
nesia acidulated with sulphuric acid, and the natural mineral 

*An?iales de Gynaecologie, Jan., 1876. 



23O DISORDERS OF PREGNANCY. 

waters. He promotes diaphoresis by the vapor and hot air bath, 
or the Turkish bath if accessible. Vichy and Seltzer waters are 
well borne. Cupping, wet or dry, over the kidney, particularly 
when there is pain over it, and the urine is scanty, or smoky. A 
hard bounding pulse, severe pains in the head, flushed and hot 
skin may be met by venesection, though in many instances saline 
laxatives, freely used, will overcome these symptoms. 

Counteract the impoverished state of the blood resulting from 
the loss of albumen by good nutritious food, fresh air, an appro- 
priate mode of life and tonics. Generally white meats and fish 
are well borne. Milk is excellent as a diet. The tincture of the 
chloride of iron is the best tonic. It should be given largely dilu- 
ted, and not to the extent of blackening the feces. 

Quiet the nervous and digestive disturbances by complete regu- 
lation of the habits and mode of life, and an out-of-door life short 
of fatigue ; constant and cheerful occupation for both mind and 
body. Avoid opiates, but give nervous sedatives or soporifics that 
are non-constipating, as chloral in severe cases. The bromide of 
potassium and the monobromide of camphor are useful. They 
ameliorate the condition, and give considerable immunity against 
convulsions at the time of labor. For the loss of appetite and con- 
stipation, pepsin, bismuth, and nux vomica, are serviceable. 

Induce premature labor when all else fails. 

DR. A. S. COE, OF NEW YORK. 

According to this practitioner (Am. Jom. Obstetrics, Oct., 1878) 
when albumen makes its appearance early in pregnancy, there are 
three important indications to be met: (1) to eliminate the poison 
as far as possible ; (2) to support the patient; (3) to allay the ner- 
vous tension, and guard against exciting causes. In the first, ace- 
tate or some of the other salts of potassa, with digitalis, acts favor- 
ably upon the kidneys, and diminishes the quantity of albumen in 
the urine. Much of the poison can be eliminated by the action 
of saline cathartics upon the bowels. The second is best met by 
a liberal diet, tonics, and iron. To meet the third, absolute rest 
and quiet are neces-sary, with the use of opium and bromide of 
potassium, if an outbreak of convulsions or other paroxysms is 
threatened. When there is much cerebral disturbance, the appli- 
cation of ice to the back of the head and upper part of the spine 
answers an excellent purpose. 



ALBUMINURIA OF PREGNANCY. 23 1 

Convulsions are usually preceded by a rapid accumulation of 
uric poison in the blood and a scanty secretion of urine, and often 
the patient is attacked with only a slight premonition of coming 
disaster.- In the treatment of these cases, he has found that sulph. 
morphia, injected hypodermically, answers the best purpose. He 
never was able to get satisfactory results from bleeding or the 
use of chloroform. 

PROF. J. B. FONSSAGRIVES, M. D., PARIS. 

This author considers it doubtful whether any direct means are 
available to combat the superabundance of albumen in the serum ; 
but indirectly much can be done by regimen and diet. One of the 
most important points is to keep the bowels soluble by laxatives ; 
constipation in such cases^must be sedulously avoided by means of 
alkaline purgative waters, in doses sufficient to act moderately and 
no more. 

Whether the diet recommended in Bright's disease should also 
be adopted in the albuminuria of pregnancy, remains an open 
question. Often by attention to the bowels and general regimen. 
no such means need be resorted to. 

PROF. CARL R. BRAUN, M. D., VIENNA. 

Hydremia, at an early stage of pregnancy, is ameliorated by 
nutritious diet, vegetable tonics, and iron, tepid baths, and espec- 
ially vapor baths. To neutralize the carbonate of ammonia in the 
blood, make use of benzoic acid, lemon juice, or tartaric acid. To 
obviate congestion of the head, prevent constipation by vinegar 
injections, aloes, jalap, etc. When exudation has taken place into 
the Malpighian capsules, and the tubuli of Bellini and Ferrein, the 
cylindrical clots must be removed from them, and new ones pre- 
vented. If the current of fluid from the bodies into the capsules 
be strong, then the copious use of diluents will suffice to wash 
away the clots. But if the urine be scanty and uremia threaten, 
then the force of the current must be increased by acids, as above, 
and Seltzer and Vichy waters. Pills of tannin and extract of aloes 
are useful to restore the normal tone. 

Premature delivery is not to be thought of, unless uremia has 
appeared, and the life is threatened. But it will be rational to 
resort to this procedure if from the duration of the disease, its 
severity, the quantity of cylindrical clots, the great hydremia, the 



2 3 2 DISORDERS OF PREGNANCY. 

dropsy, and disturbances of the heart, lungs, brain, etc., cause fear 
of the existence of great degeneration of the kidneys. Should 
symptoms indicate the death of the foetus, operative interference 
may at once be employed, as its retention greatly adds to the 
danger to the mother. 

RESUME OF REMEDIES. 

Benzoicum Acidum, gr.v, twice daily, in pill form, has given satisfactory 
results in uremic attacks during pregnancy. 

Chloral has been tried with marked success in a few cases by Dr. E. 
Noegg erath, of New York. (Amer. Jour, of Obstetrics, Oct. , 
1878). He gave gr. xx-xxx every night, with the result that 
the albumen immediately began to diminish, and soon disap- 
peared entirely. 

Digitalis. The duretic powers of this drug are frequently available. It 
can often be advantageously used as a poultice as recommended, 
by Dr. P. C. Russel {Brit. Med. Jour., December, 1878). 

Ferrum. The use of ferruginous preparations combined with diuretics is 
always indicated. 

Taborandl and Pilocarpln must be used cautiously in these cases, as they 
have ecbolic properties which may lead to abortion. 

Oleum Juniperi was preferred by Simpson as a diuretic, but has not been 
approved by others. 

Oleum Tlglli is occasionally called for in severe cases, to act on the bowels 
and kidneys. 

Poiassll Acetas and Bitartras usually secure an abundant renal secretion. 

Potassii Bromidum is valuable to relieve headache and control nervous 
excitement. 

Milk Diet. A diet of skimmed milk is probably the only remedy now 
known which has a radical influence on albuminuria. 

On the general treatment of Albuminuria, see the section on Eclampsia, 
and also Napheys' Medical Therapeutics \ Chap. V. 



CHAPTER II. 

COMPLICATIONS, DISORDERS, AND SEQUELS 
OF PARTURITION. 

Anesthetics in Labor — Tedious Labor {Rigid Os } Uterine Atony, 
etc) — After Pains — Puerperal Hemorrhage — Puerperal Eclamp- 
sia — Puerperal Mania — -Puerperal Septicemia — TJirombosis and 
Embolism — Shock — Pelvic Cellulitis and Peritonitis (Puerperal 
Phlebitis and Metritis) — Phlegmasia Dolens — Milk Fever — Puer- 
peral Convalescence. 

ANESTHETICS IN LABOR. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

Anaesthetics are of great value in preventing lacerations of the 
perineum. In that form of rigidi'y caused by excessive irritability 
of the muscular fibres, the perineum relaxes and dilates with re- 
markable rapidity after the inhalation of chloroform. Where dan- 
ger arises from violent uterine contractions, profound anaesthesia 
will save the perineum. Even in tedious labors, chloroform causes 
relaxation and a restoration of the normal moisture and tempera- 
ture of the parts, and efficient action of the uterus is at once 
resumed. 

PROF. KARL SCHROEDER, ERLANGEN. 

Chloroform in labor has the same advantage as in surgical 
operations. It facilitates all midwifery operations. In parturition, 
it easily acts in a small quantity, and it is not necessary to pro- 
ducec omplete anaesthesia merely to mitigate pain. A few whiffs 
relieve the acute pain, and this cannot injure mother or child. 
Even profound anaesthesia has not been found to influence the 
child when continued for a short time. 

It does not induce hemorrhage, and reduces the temperature, 
both favorable effects. 

It cannot be questioned that chloroform is advisable in normal 

( 2 32>) 



234 COMPLICATIONS OF PARTURITION. 

parturition to suppress the intense sufferings. Chloral has an 
equally beneficial effect. 

PROF. S. W. PLAYFA1R, M. D., LONDON. 

Anaesthesia is a perfectly legitimate means of assuaging the 
sufferings of child-birth. Chloral may be safely given when 
chloroform cannot. It does not relax contractions, while it pro- 
duces a drowsy state, in which the pains are not so acutely felt. 
Hence, in the first stage, during the dilatation of the cervix, it is 
most useful ; especially in those cases where the pains are intolera- 
bly acute, with but little effect on the labor, 15 grains may be 
given every twenty minutes, for three doses ; the patient becomes 
drowsy, dozes, and wakes up as each contraction commences. 
Rarely is a fourth dose required. It does not interfere with the 
use of chloroform, but of that less will be required. It is a very 
valuable aid in the management of labor. 

Chloroform should only be given during the pains, and never 
to unconsciousness. Watch its effects : if the pains lessen in force 
and frequency, stop its inhalation, beginning again when the pains 
are stronger. It is believed that the addition of about one-third 
absolute alcohol will increase the stimulating effects and diminish 
its tendency to cause undue relaxation. As the head distends the 
perineum, it may be used more freely, and even to complete insen- 
sibility just before the child is born. 

Ether acts well, and does not relax the uterus, and even seems 
to intensify the pains. 

Bear in mind the tendency of chloroform to produce uterine 
relaxation, and hence take extra precautions against post-partum 
hemorrhage. 

In operative midwifery, complete anaesthesia is required, and 
here the operator should employ the aid of another physician, and 
his undivided attention should be given to the anaesthetic, while 
the operator is otherwise engaged. 

Dr. Robt. P. Harris, American editor of Playfair, says that in 
the United States chloroform is rarely used in midwifery, but 
preferably pure sulphuric ether. After anaesthesia, uterine inertia 
is very apt to follow, and result in post-partum hemorrhage. 

DR. FRACHAUD 

Read a paper before the Section of Obstetrics and Gynecology of 



ANESTHETICS IN LABOR. 235 

the International Medical Congress, on the nth of September, 
1S78, on anaesthetics. The following are his conclusions : 

(1) The employment of anaesthetics is to be advised, as a gen- 
eral rule, in natural labor. 

(2) The principal agents employed at present, are ether, chloro- 
form, amylene, laudanum, morphine by subcutaneous injection, 
and chloral by the mouth and by enema. 

(3) Chloroform is the one he considered preferable. 

(4) It should be administered according to the method of Snow, 
that is, in small doses at the commencement of each pain ; and it 
should be suspended as soon as the pain has passed. 

(5) It should never be pushed to complete insensibility, but a 
diminution of pain only should be aimed at. 

(6) It is generally advised to administer chloroform only during 
the period of expulsion ; but in some cases of extreme nervousness 
and agitation, it is better not to await the complete dilatation of 
the os. 

(7) Experiment has shown that anaesthetics do not stop either 
the uterine contractions or those of the abdominal muscles, but 
that they lessen the resistance of the perineal muscles. 

(8) The employment of anaesthetics has no injurious effect on 
the health of mother or child. 

(9) In lessening to a greater or less degree the sufferings of the 
woman, anaesthetics are of great service to those women who dread 
the pain ; it lessens the probability of their having nervous attacks,, 
and hastens their convalescence. 

(10) Anaesthetics are extremely useful to calm the extreme 
agitation and control excitement which labor often causes in very 
nervous women. 

(11) Their employment is indicated in cases of natural labor, 
which is suspended or retarded by the sufferings caused by previ- 
ous disease, or that coming on during the labor, and in cases 
where irregular and partial contractions occasion great suffering 
without advancing the labor. 

(12) Chloroform should not be employed in natural labor with- 
out the. consent of the woman and her friends. 

M. Courty spoke in high terms of M. Frachaud's paper, and 
stated that he agreed with him in every particular. 



236 COMPLICATIONS OF PARTURITION. 

PROF. F. CHURCHILL, M. D., DUBLIN. 

In most obstetric operations, anaesthesia is of value to relax the 
soft parts and moderate uterine action, etc. 

The dose should be administered at each pain, and increased 
when the head is passing the perineum. The anaesthetic state 
may be kept up for hours without mischief. The best mode is 
by a clean white handkerchief, folded funnel shape, into which a 
drachm and a half of chloroform is poured; this is placed over the 
mouth and nose, and it is a good plan to let the patient hold it 
herself, as thus deep anaesthesia is prevented. 

C. J. CAMPBELL, M. D., PARIS, 

Has for years employed chloroform in labor with good results. 

The rtdministration of chloroform in intermittent doses, during the 
second stage of labor, is of undoubted value. Had it no other but 
a moral effect on the patient, even then it would be most valuable, 
inasmuch as it abolishes the dread of coming pain, and enables her 
to enter labor with confidence and tranquillity. But chloroform, 
without diminishing the force of the uterine contraction, relaxes 
the parturient canal, abolishes the sensation of the straining pains 
which during this period are most violent and agonizing, and 
economizes the mother's strength by sparing her the exhaustion 
consequent upon the extreme tension of the nervous system. 
With regard to post-partum hemorrhage, the danger is infinitesi- 
mal, if the chloroform be withdrawn at the conclusion of the 
second stage. 

M. LUCAS CHAMPIONNIERE, PARIS, 

Says (Le Progres Med., Apr. 6,) that he uses chloroform in almost 
every case, but not to complete anaesthesia. Its action varies, 
requiring a larger amount and longer time in some than in others. 
Early in labor a quite small quantity gives great relief, and yet the 
labor goes on rapidly. Later, it requires a greatly increased dose, 
and the anaesthesia must be more profound, and must be main- 
tained. When the waters are evacuated and the uterus firmly 
contracted on the child, the resistance is greatly increased, and 
more trouble is experienced in obtaining the good results. Here 
the chloroform may be pushed until sleep is induced. This author 
finds that it never retards labor, generally accelerates it, does not 
cause stupor in the child, and the woman has a better convales- 



ANAESTHETICS IN LABOR. 237 

cence in every way. He has seen no contra-indications to its use 
in any case. 

PROF. WM. T. LUSK, M. D., NEW YORK, 

In a paper " On the Necessity of Caution in the Use of Chloro- 
form During Labor," states the following propositions: 

I. Deep anaesthesia, carried to the point of complete abolition of 
consciousness, in some cases weakens uterine action, and some- 
times suspends it altogether. 

II. Chloroform, even when given in the usual obstetrical fashion, 
namely, in small doses, during the pains only, and after the com- 
mencement of the second stage, may, in exceptional cases, so far 
weaken uterine action as to create the necessity for resorting to 
ergot or forceps. 

III. Patients in labor do not enjoy any absolute immunity from 
the pernicious effects of chloroform. 

IV. Chloroform should not be given in the third stage of labor. 
The relative safety of chloroform in parturition ceases with the 
birth of the child. 

V. The more remote influence of large doses of chloroform 
during labor upon the puerperal state, is a subject that calls for 
further investigation and inquiry. 

With these five propositions he is prepared to close his indict- 
ment against chloroform in midwifery. It is not a formidable one, 
and need not deter from its cautious employment. But the sense 
of possible danger which governed its use in the hands of those to 
whom we owe its introduction into practice, has been replaced by 
an overweenine confidence. 



■& 



PROF. R. BARTHOLOW, M. D., PHILADELPHIA, 

Says when labor is of short duration, and not excessively painful, 
anaesthetics are not to be used. But when the labor is protracted 
and suffering great, they favor progress, and prevent exhaustion 
and uterine inertia. Caution is required with primipara. Inhala- 
tion should not begin till the close of the first stage, unless there 
are " nagging pains," and only during a pain. The effect must be 
watched, and the inhalation stopped if the pulse fails, the respira- 
tion becomes short, and the pains lose efficiency. Complete un- 
consciousness is not necessary. 

In instrumental delivery, anaesthesia is important ; it facilitates 



238 COMPLICATIONS OF PARTURITION. 

the operation, and prevents shock. It must be carried so far as 
to ensure quietude of the patient, but not complete muscular reso- 
lution. In turning, chloroform narcosis must be deep enough to 
suspend uterine contraction. 

RESUME OF REMEDIES. 

Alcohol. In default of other anaesthetics, a full dose of whiskey or other 
spirits is a popular obtunder of pain. By some obstetricians a 
mixture is used containing alcohol, as that proposed by the 
Medico-Chirurgical Society of London. 

262. I£. Alcoholis, 1 part 

Chloroformi, 2 " 

Etheris sulph., 3 " M. 

Chloral has been suggested, but its absorption is slow and its results un- 
certain. Injecting it into the veins, after the method of Dr. 
Ore, of Bordeaux, is said to be dangerous. Playfair prefers 
chloral to chloroform ; he gives gr.xv at a dose, and repeats in 
twenty minutes, if necessary. 

Chloroform. Simpson recommends chloroform to be used in labor, by 
laying a single fold of a handkerchief over the nose and mouth, 
and dropping the anaesthetic upon it, a single drop at a time. 
In this way it becomes thoroughly mixed with air, and is en- 
tirely safe. Drs. J. Ringer, Playfair, and others, believe that 
chloroform weakens uterine contraction. According to a recent 
writer in La Press e Medic ale, chloroform acts more vigorously 
and persistently upon the retractility than upon the contractility 
of the womb. To secure this action, prolonged inhalations, 
rather than complete anaesthesia, are desiderated. The con- 
traction of the abdominal muscles is more diminished by the 
chloroform than uterine contraction is. But whilst both these 
effects of this anaesthetic are in proportion to the intensity of 
the anaesthesia, they disappear rapidly, indeed, almost instanta- 
" neously, on the cessation of the inhalation, whilst the diminution 
of uterine retractility continues longer. 

Ether. Pure, well-washed, sulphuric eother, is claimed by many to com- 
bine more in its favor as an anaesthetic in labor than any other 
agent. But as Dr. R. P. Harris points out (notes to Play- 
fair's Midwifery), only in exceptional cases does it act satisfac- 
torily. In many it induces intoxication and excitement, and 
diminishes or stops the expulsive efforts, and leads to uterine 
inertia and consequent post partum hemorrhage. Its adminis- 
tration should be preceded by a small dose of brandy, to pre- 
vent gastric disturbance. 

Morphia. The hypodermic injection of morphia has been found to 
arrest uterine contraction, and is therefore not adapted to 
labor. 

Nitrous Oxide, a safe and agreeable anaesthetic, produces an influence 
of too short duration to be conveniently employed in obstetrics. 



TEDIOUS LABOR. 

RIGID OS AND ATONY OF UTERUS. 
ALBERT H. SMITH, M. D., PHILADELPHIA, 

In a paper read before the Philadelphia County Medical Society, 
[Medical and Surgical Reporter, Aug. I ith and 18th, 1877), says the 
causes of delay may be divided into classes : Rigidity of the os 
or absence of the dilatory force, or real and apparent rigidity. 
Spasmodic contraction of the os. is a neurosis, and for its relief we 
require such means as quiet nervous excitement, allay sensibility, 
diminish the activity of the circulation, and control the local con- 
gestions. First of these is opium. Acts promptly, without danger, 
and never contra-indicated. A suppository of one-half a grain to a 
grain of watery extract, or its equivalent in morphia, powdered 
opium, or an enema of laudanum, or the hypodermic ; or in case 
of much fever, morphia with digitalis and diaphoretics, will be 
certain of good results. 

Ether or chloroform may give the same, but are not so safe, and 
diminish the force of the contractions, and may cause inertia uteri 
and hemorrhage. 

Passive rigidity, that is, a want of distensibility, must be met 
by the douche of hot water, 105 to no°, injecting a quart at a 
time by the syringe against the os and cervix, and repeating every 
hour or two. Traction by the finger upon the anterior lip is here 
of great value, though not when there is spasm. When the mem- 
branes are not ruptured, care should be taken not to do this. The 
india-rubber bags are valuable dilators — that of Braun, of Vienna, 
or better, the fiddle-shaped bags of Barnes ; they should be filled 
with warm water until fully expanded. After dilatation has given 
room, apply the forceps within the lips, and thus we gain an addi- 
tional dilating power. There can be no more risk to the tissues 
than by the passage of the head without them, During each con- 
traction the forceps may be gently drawn upon. 

Incision is justifiable only under extremely rare conditions. 

In delay from absence of the dilating wedge, which is the most 
common cause of delay, this is often the result of inertia, and may 
be met by abdominal frictions, diffusible stimulants, ginger, balm, 

( 2 39) 



240 COMPLICATIONS OF PARTURITION. 

mint, or other hot teas, hot and cold douche, etc. The best of all 
is the bisulphate of quinia — say 15 grains in one dose. 

When the preternatural distension of the amniotic sac stretches 
too greatly the uterine fibres, its rupture will generally speedily 
correct the evil. Irregular contractions are best met by the quiet 
and rest of opium, anaesthetics, chloral, etc. 

Premature labor would also cause delay, and require opium or 
chloral for relief. 

In cases of disproportion of the head and pelvis, the one abnor- 
mally large, or the other small, the only remedy is to carry the 
forceps within the os, and the accomplishment of the delivery as 
above detailed. 

W. H. LONG, M. D., LOUISVILLE, KY., 

Speaks oiviscwn album or mistletoe as an oxytocic. He has used 
it for ten years. It acts with more certainty and promptness than 
ergot, and does not cause continuous or chronic contractions. 
The fluid extract is preferable, in doses of a drachm, repeated every 
twenty minutes until the desired effect is induced. The infusion is 
made by taking 2 oz. of the dried, or 4 oz. of the green leaves, 
pouring over them one pint of boiling water, covering until cool 
enough to drink. Dose, two to four ounces, repeated in twenty 
minutes, if necessary. He has seen excellent results follow its use 
in post-partum hemorrhage and in menorrhagia. 

J. H. BENNETT, M. D., WAUSEON, OHIO, 

Proposes (Detroit Lancet) to facilitate and shorten labor by giving 
a hypodermic of morphia, gr. J^. When rest has restored the 
nervous energy, he places the patient on her back, the thighs 
flexed, the shoulders bolstered up, the smaller or lumbar portion 
of the spine down, so as to form a curve, the convexity of which is 
down ; thus the axes of the two straits form a continuous curve. 
Labor commencing, the os is gently pulled forward by the index 
finger, causing dilatation, at the same time pressing the fundus 
gently upwards and back so as to bring the child in proper relation 
with the lower strait. During the passage of the head into the 
lower strait, he continually draws forward the anterior lip of the 
os, at the same time pressing the anterior portion of the os back 
under the os pubis, with other soft tissues that protrude with the 
anterior portion of the os and neck, which narrows the antero-pos- 



TEDIOUS LABOR. 24 1 

terior diameter. As the os dilates under the forward and lateral 
pressure, during the interval of pain, the anterior lip of the os 
passes back under the arch of the pubis, and finally over the 
occiput; thus increasing the anteroposterior diameter and facilita- 
ting very much the passage of the head, also saving the contusion 
of the urethra, which so frequently occurs. 

After this stage he protects the urethra and tissues adjacent, by 
pressing upon the occiput forwards and downwards with the digital 
and middle fingers, each side of the urethra, until it passes from 
under the os pubis ; thus avoiding the necessity of 'being called to 
use the catheter, also preventing one of the causes of vesico-vaginal 
fistula, and lessening the danger of laceration of the perineum by 
the occiput rising in front of the os pubis, sooner than it would if 
the anterior portion of os with folds of the vagina and other soft, 
parts protruded in front of the head. In this way the pressure on 
the perineum is lessened. 

During the above management, if the patient is weak and the 
pains feeble, to induce instinctive action of the uterus and abdom- 
inal muscles, pass the middle and index fingers of the right hand 
(the palmar surface down) back with gentle pressure downwards 
against the perineum and vulva, producing the sensation of ad- 
vance of the head. 

HENRY L. HORTON, M. D., NEW YORK, 

{Am. Jour. Obst., July, 1878,) states that atropine injected into 
the tissues of the cervix uteri will lessen the pain and shorten the 
duration of the first stage of labor, by overcoming the spastic 
rigidity of that structure. He uses about one-fortieth or fiftieth 
part of a grain of atropia sulphate for each injection. He has had 
manufactured a hypodermic syringe, long needle with a hook- 
curve at the end. "After hooking the anterior lip of the cervix 
with the index finger of the right hand and drawing it slightly 
forward, he carries the needle along the palmar surface, keeping 
the point pressed quite firmly against it, so as to avoid wounding 
the maternal parts. After carrying its points well within the 
cervix, he raises it from the finger, and by a slight traction, buries 
it somewhat deeply into the muscular structure of that portion of 
the uterus. After discharging its contents, he retains it in that 
position a few moments, in order that the absorption of the atro- 
pine may be certain to take place." 
16 



242 COMPLICATIONS OF PARTURITION. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

Where there is feeble or irregular action, a loaded rectum is 
often the cause, and a large enema will generally produce a 
remarkable effect. 

Excessive distension of the uterus is relieved by rupture of the 
membranes. Adherent membranes may be separated by sweeping 
the finger or a flexible catheter round within the os. Uterine 
deviations must be corrected by placing the patient on the oppo- 
site side to that towards which the organ points, or when anterior, 
place her on her back and apply a bandage to prevent the organ 
falling forward. Temporary exhaustion requires rest, as by an 
opiate, as 20 minims of Battley's solution or an enema of the same. 
When pains are irregular, spasmodic and painful, chloral is of 
great value. 

Oxytocics or remedies to increase the force of the pains, are 
borax, cinnamon, quinine, galvanism, and ergot. The latter has 
serious disadvantages to both mother and child. It is only allow- 
able when the os is fully dilated. 

Manual pressure often produces the most speedy effect. The 
best way is to place the patient on her back at the edge of the 
bed, and spread the palms of the hands on each side of the fundus 
and body of the uterus, and when a pain begins, make firm pres- 
sure down and back in the direction of the outlet ; relax the pres- 
sure when the pain goes off; and resume when a new pain comes. 
The patient need not lie on her back; pressure may be made in 
the ordinary obstetric position on the left side, the left hand spread 
over the fundus, leaving the right free to note the progress per 
vaginam. This plan is completely at the will of the operator, and 
can be nicely regulated ; it imitates nature, and is without risk to 
child or mother. The pressure must be firm, but not rough. The 
use of the forceps is now becoming the rule in place of the excep- 
tion, to put an end to protracted labor. It diminishes in a marked 
degree infant mortality. There is no danger to the mother, but 
often great danger from a delay in their use. 

PROF. WM. LEISHMAN, M. D., GLASGOW. 

In rigid os, anaesthetics are required. Chloroform is preferred, 
but chloral is more marked in its effects. When the os seems 
occluded, mechanical means to dilate must be employed, as 
sponge-tents, and the like. Inertia of the uterus may be caused 



TEDIOUS LABOR. 243 

by rheumatism, neuralgia, etc. A distended bladder or rectum 
may act mechanically, and in such cases there is generally cramp 
of the lower limbs, and this agony weakens the action of the 
womb. The means of relief here is patent and immediately effi- 
cient. 

Ergot, to increase the activity of the pains, is never perfectly 
safe, and the forceps should, when possible, be preferred. 

ALFRED MEADOWS, M. D., LONDON. 

Tartar emetic will be found of the greatest service in small and 
frequently-repeated doses, so as to cause nausea, when the rigidity 
readily yields. Sometimes it appears to act better when combined 
with opium, or is facilitated by saline purgatives, as where there 
is gastric derangement, with foul tongue, offensive breath, con- 
stipation, etc. 

Opium alone is of the utmost value. Chloroform is another 
valuable remedy. Bleeding, in plethoric subjects, requires a full 
stream, to the amount of twelve or sixteen ounces. A vaginal 
pessary — one part gelatin, four of glycerine, made with two or 
more grains of extract of belladonna, soon melts and is absorbed, 
and may aid the dilatation. In certain cases all these fail, and we 
require the artificial dilator, the india-rubber bag. Where rigidity 
is obstinate, and there is fear of uterine rupture, or exhaustion of 
the patient, the cervix should be incised, not too deeply, say from 
a quarter to half an inch in several directions. 

ARTHUR WIGLESWORTH, M. D., LIVERPOOL. 

This writer (Obstetric Journal Great Britain and Ireland, Sept., 
1877), advances these propositions: An os more or less dilated, 
but rigid with active contractions, is rigidity from spasm ; this may 
arise from direct or indirect causes, but with the same results ; this 
condition may be removed by the administration of morphia, with 
the object of relaxing the circular fibres without inducing either 
nausea or exhaustion. The dose must be regulated according to 
physical condition of the patient, the amount of rigidity, the con- 
dition of the stomach. A nervous, excitable temperament requires 
a smaller dose than a phlegmatic one, also if there is much ex- 
haustion. A thick rigid os, with a phlegmatic system, requires a 
larger dose, or a repetition. If the stomach is loaded, a larger 
dose is required. 



244 COMPLICATIONS OF PARTURITION. 

Where rigidity has been long existent, and there is exhaustion 
without relaxation, and a subsidence of uterine action, ergot and 
morphia should be combined. 

WM. STEPHENSON, M. D., LONDON, 

In the Obstetric Journal Great Britain and Ireland, Aug., 1878, 
directs the introduction of one or more fingers of the right hand 
within the os, opposite the thyroid foramina in first and second 
positions, and the sacro-iliac junction in the third and fourth, and 
thus to lift or support the head during each pain. His design is 
to effect the extrusion of the occiput through the os, securing 
greater flexion and aiding rotation. It is employed after rupture 
of the membranes, before complete dilation, and when the cervix 
does not yield and recede over the head. 

RESUME OF REMEDIES. 

Alcohol counteracts the tendency of anaesthetics to weaken uterine 
action, and acts as a general stimulant to the muscular forces in 
labor (Dr. D. Morton, Amer. Practitioner, Dec, 1874). 

Antimo7iii et Potassaz Tart/as, in tedious labor from rigid os, in doses of 
g r . 2V-T2 every fifteen minutes, is an ancient and often efficient 
method of overcoming spasmodic muscular contraction. 

Amy I Nitrate. When the uterus is spasmodically contracted on the foetus, 
Dr. Maury, of New York, believes that this agent is a most 
valuable remedy. 

Atrppia is given by Dr. Horton, as above (see p. 241), in cases 
where the uterus has btcome completely or partially spas- 
modically contracted on the fetus, or on a # .separated placenta, 
in order to overcome the spasm. Dr. Frankel, of Breslau, 
recommends a hypodermic of one-thirty-third of a grain of 
atropia, and one- quarter of a grain of morphia, with inhalation 
of chloroform five minutes later. The uterus relaxes speedily 
and yieldingly. There need be no fear of post-partum hemor- 
rhage. 

Belladonna, in the .form of ointment of the extract, is an agent of old 
renown. 

Carbonis Sulphiditm. Milne Edwards and Varaseau assert that a few 
drops sprinkled on the abdomen of a woman in labor, will 
reawaken uterine contraction. 

Caulophylhim Thalictroides. At a meeting of the Obstetric Section of 
the New York Academy of Medicine, Dr. Sell related a case 
as an example of several, in which he used the concentrated 
tincture of caulophyllum, blue cohosh or squaw-weed, with the 
happiest results, as a remedy to ward off tedious labor. The 
remedy was especially applicable in those cases in which the 
woman had habitually suffered severely during the first stage of 






TEDIOUS LABOR. 245 

labor. As a preparatory remedy in such cases, it should be 
administered in twenty-drop doses three times a day, for three 
or four weeks previous to confinement. 
Cannabis Indica. Dr. Alex. Christison claims that cannabis inrfica 
equals ergot, but being quicker, more energetic, but of shorter 
duration. 
Chloral acts at times indirectly as an pccelerator of parturition. Dr. 
W.m. L. Richardson remarks {Trans. Am Gyn. Soc ., Vol. I ) 
that it seems especially adapted to that large class of cases in 
which the pains occur at very short intervals, last but a moment, 
and are very severe. Little progress is made, and the patient 
suffers intensely, and becomes restless and nervous. In such 
cases the administration of chloral is followed by the happiest 
results. The dose may be gr.x-xx, repeated if called for. Dr. 
T. A. Reamy, of Cincinnati, says that close observation has 
convinced him that no bad effects on the child follow the 
administration of this drug {Obstetric Gazette, Nov., 1878). 

Chloroform, administered for its anaesthetic properties, will often do away 
with spasmodic rigidity of the os. 

Cimicifuga Racemosa is alleged by the eclectics to exert some ecbolic 
powers. Cimicifitgin is extolled as of great value as a substitute 
for ergot, acting speedily and energetically. The contractions, 
unlike ergot, are not powerful and continuous, and hence there 
is less danger to the child. After labor, it allays nervous 
excitement and relieves the after pains, and checks hemorrhage. 
(Phillips.) 

Cinnamom>/m has some slight power as a uterine stimulant. 

E?gota. The accelerator of uterine contraction is par excellence the 
ergot of the cereals ; that of rye is usually employed. The pro- 
priety and rules' of its use have been much and variously debated. 
Points generally agreed upon are that it should not be given if 
there is rigidity of the os. nor until the os is dilated or dilatable. 
The contractions it causes are continuous and violent; hence it 
is suited to the third stage only. 

Gelsemium is a valuable remedy in cases of rigid os during labor, gtt.v 
of the fluid extract every ten minutes until there is nausea. 

Ipecacuanha. In cases of irregular uterine action, and protracted, agon- 
izing, yet insufficient pains, this drug exercises the happiest 
powers, relieving the pain and hastening the termination of the 
labor. The dose maybe gr.ij every fifteen minutes; it takes 
effect in about thirty minutes. A very favorite form with some 
practitioners is "Dover's powder" in repeated small doses, com- 
bined cither with ergot or chloral, as occasion demands. 

Lobelia Inflata is asserted by Scudder and other eclectics to be a specific 
in rigid os. It probably acts from its nauseating properties. 
They prescribe : . 

263. R. Tinct. lobeliae, f.5j 

Aqu?e, f-Bi y - M. 

A teaspoonful every fifteen minutes. 



246 COMPLICATIONS OF PARTURITION. 

Oleum Ricini in small doses, for some time before labor commences, is 
said to facilitate it. 

Opium and its alkaloids are of advantage to control the nervous restless- 
ness and exhaustion which supervene in tedious labor, and to 
lessen the spastic rigidity of the os. Small quantities, gr. \, of 
morphia, in camphor water, may be given hourly or half-hourly. 
Of its employment during labor Dr. Lusk says that from a 
number of observations, there is no reason to apprehend any 
direct effect on the child from morphia hypodermically adminis- 
tered to the mother during labor. The propriety of its use, 
therefore, is to be determined by purely obstetric considerations. 
When given to meet some urgent need in the mother, it proba- 
bly conduces indirectly to the welfare of the child. 

Quinia. That sulphate of quinine has a direct power to promote normal 
labor, cannot longer be disputed. Dr. Albert H. Smith, after 
a careful study of the subject, said some years ago (Obstet. 
Jour., June, 1875,) tnat ^ " increases the activity of the normal 
uterine contractions ; the pains becoming more frequent and 
more intense, the expulsive power being greater, while the 
yielding of the circular fibres of the os is more prompt ; the 
contractions maintaining their proper intermittent character, 
the relaxation and rest in the interval being complete ; showing 
in this respect an entirely different action from the continuous 
spasmodic contraction caused by ergot. ... It promotes 
permanent tonic contraction of the uterus after the expulsion of 
the placenta. ... It diminishes the lochial discharge to a 
normal standard. ... Its use is followed by *less after- 
pains than usual, in a majority of cases. . . . Given 
during parturition, it never disturbs the brain or causes its usual 
unpleasant effects, even in patients who at other times are very 
susceptible to its influence." The dose is gr.xv, repeated if 
necessary. Others give gr.viij-x. 

Sodii Boras has a doubtful claim to being an oxytocic. 

Ustilago Maidis, the ergot of^maize, has been recently introduced. It 
is not dissimilar from other ergots. 

Viscum Album, the mistletoe, has alleged parturifacient properties. (See 
p. 240). 

EXTERNAL MEASURES. 

Abdominal Friction is an excellent agent for expediting labor. Much 
force should not be used. The object is by gentle friction and 
pressure to excite uniform and effective uterine contractions. 

Dilatation of the os by the finger has been strongly recommended by Dr. 
James Braithwaite, where the rigid os gives rise to symptoms 
of exhaustion. In the method he employs, the right index 
finger is introduced within the os uteri, with its palmar surface 
toward the sacrum; the left index finger is then passed, with its 
palmar surface toward the pubes, the left hand crossing over the 
right for this purpose. By gentle pressure in opDOsite direc- 
tions the os is readily made to dilate ; the fingers being hooked 



TEDIOUS LABOR. 247 

within the os, the pressure is also made downward, thus very 
closely resembling the natural process. As soon as the os is 
dilated to the size of a five-shilling piece, two fingers of each 
hand can be introduced for manipulating. 

Electricity has been employed as a uterine stimulant, but it has proved 
inconvenient in practice, not easily manageable, and not very 
effective. 

Incision of the os, as a surgical measure, may be resorted to in obstinate, 
and especially in cicatricial rigidity. 

Injections of warm water into the vagina, in properly chosen cases, will 
accelerate the labor without causing any increase of suffering 
to the mother. The only instrument required, besides a bowl 
of warm water, is a syringe fitted with a vaginal tube ; but this 
apparatus can be improved by the addition of a yard of india- 
rubber tubing, three-eighths of an inch in diameter, joined to 
the vaginal tube sq as to carry off the water direct from the 
vagina into a receptacle, thus avoiding wetting the bed. The 
water should be as warm as the patient can comfortably bear, 
and in practice it is advisable not to begin with water raised to 
the full temperature, but gradually to add boiling water until 
the temperature of about 105 F. has been attained. The 
injection requires to be continued from five to twenty minutes, 
according to circumstances. 

Hip-Baths, as hot as the patient can comfortably bear, will often expedite 
labor, and relieve the patient in the most satisfactory manner. 

Venesection, in cases of obstinate spasmodic contractions, is hardly ever 
necessary, now that the means above enumerated are within our 
reach. 



AFTER-PAINS. 

ALFRED MEADOWS, M. D., LONDON. 

This author believes after-pains to be healthful in a certain 
sense ; but if excessive, he would give henbane and camphor, 
lettuce and chlorodyne, morphia, which is better than opium, and 
the liquid extract of the British Pharmacopceia is the best of the 
opiates. The regular application of the child to the breast suffices 
to expel clots from the uterus. 

PROF. W. S. PLAYFAIR, M. D., LONDON, 

Advises an opiate, or if the lochia be scanty, a linseed-meal poul- 
tice sprinkled with laudanum, or the chloroform and belladonna 
liniment. Quinine in ten-grain doses is excellent, especially when 
the pains are neuralgic in character. 

PROF. TYLER SMITH, M. D., LONDON, 

Counsels the removal of any coagula that may be in the uterus. 
When the pains are neuralgic, an opiate, and a warm linseed-meal 
poultice, with laudanum sprinkled on it, applied to the abdomen, 
afford great relief. An anodyne embrocation applied to the 
breasts is of service. 

BERNARD KELLY, M. D., OF LONDON, 

Has found {Medical Press and Circular, Feb. 20, 1878,) small doses 
of opium, frequently repeated, combined with an alkali or acid, as 
indicated, to answer an excellent purpose. It is much safer than 
giving a single large dose, which has a tendency to suddenly 
paralyze nervous action, and subsequently lead to passive enlarge- 
ment and congestion of the uterus. This objection derives addi- 
tional force from the occasional presence (often unsuspected by the 
young accoucheur) of albumen in the urine, and the consequent 
danger of uremic convulsions ; when, if a large dose of the nar- 
cotic be blindly administered, fatal effects will almost inevitably 
follow. Here there is no remedy to compare in safety and value 
with the old-fashioned tincture of iron, which may be given, prop- 
erly diluted, in large doses and ad libitum. When pains, unat- 
tended by uterine action, follow labor, ergot may be advantageously 

(248) 



AFTER-PAINS. 249 

prescribed. But to exhibit it in cases where the viscus is already, 
so to speak, madly in action, would be simply applying spurs to 
the willing horse. 

RESUME OF REMEDIES. 

Acttea Alba. The white cohosh in tincture or infusion is alleged by the 
eclectic practitioners to be a specific in after-pains. 

Camphora, in the form of camphor water, or pills, gr.ij, of the powder, 
may be used with advantage. 

Chloral, in moderate doses, will usually be found efficient. 

Hyoscyamus is well spoken of by Dr. Meadows. 

Li/pulina, from its specific sedative effect on the generative system, has 
been suggested. 

Opium and its alkaloids are. extensively given, but may profitably be sup- 
planted by other anodynes. 

Potassll Bromidum is a safe, and usually an efficient, sedative. 

Quinice Sulphas, in doses of gr.x, repeated if required, has a great deal 
of testimony in its favor. 

Hot Water Injections. Dr. Albert H. Smith, of Philadelphia, has 
found that hot water injections, iio°-i2o° Fah., will always 
relieve, and often arrest, the most seveie foims of after-pains 
{Med. Tunes, Aug., 1879). 



PUERPERAL HEMORRHAGE. 

Hemorrhage may occur either before labor or after it. Ante- 
partum hemorrhage may be due to the existence of placenta 
praevia, which generally is manifested by the bleeding occurring 
about the seventh month ; or to the accidental detachment of the 
placenta, or the rupture of a large vessel of the mouth or neck of 
the uterus, or in the vagina. This latter may be expected where 
the presence of varicose veins is observed about the abdomen, 
thighs, etc. We have reason to believe that the same condition 
may exist within the labia and vagina. When hemorrhage occurs, 
until the os is sufficiently dilated to permit of delivery and a 
speedy termination of the labor, plugging the vagina is the only 
resource. This may be accomplished by the use of cotton, wool, 
etc., saturated in a styptic glycerine, or by the colpeurynter, which 
fully closes every avenue for the escape of the blood, and acts 
efficiently as a dilator of the os. This should never be filled with 
air, for should its walls give way above, the air would be forcibly 
driven into the uterine veins, and death would be inevitable. 

PROF. W. S. PLAYFAIR, M. D., LONDON, 

Gives the treatment by puncture of the membranes as the most effi- 
cacious; plugging the vagina, or, better, the cervix itself; turning, 
of course, when dilatation admits of it, as after the previous plan ; 
separation of the placenta, especially when the child is dead, when 
it is not yet viable, when the hemorrhage is great and dilatation is 
not sufficient for turning, when the pelvic passages are too small 
for safe and easy turning, when the mother is too exhausted to 
bear turning, when the evacuation of the waters fails, or when the 
uterus is too firmly contracted for turning. 

This operation is performed by passing one or two fingers as 
far through the os as they will go; feeling the placenta, pass the 
finger between it and the uterus, sweep it around so as to separate 
the placenta as far as can be reached; if the membranes can be 
reached and have not been already opened, tear them. Generally 

the hemorrhage soon ceases. 

He recapitulates : Before viability, temporize, by absolute rest 

in bed, cold, astringent pessaries, etc. After the seventh month, 

(250) 



PUERPERAL HEMORRHAGE. 25 I 

terminate the pregnancy. In all cases, rupture the membranes. 
It the bleeding ceases, leave the case to nature; if not, turn if it 
can be done, or plug carefully, and endeavor, by compression and 
ergot, to bring on labor. Do not leave the plug in but a few 
hours. If necessary, use Barnes' bag to dilate; this also acts as 
a plug. Separate the placenta from its attachment to the cervix. 
Of course, all these methods would apply for any form of ante- 
partum hemorrhage. The great hemostatic is uterine contraction. 

PROF. F. WINCKEL, M. D., ROSTOCK, GERMANY. 

When from absence of contractions, give ergot, 3 grams, every 
fifteen minutes; cold injections into the vagina; compression with 
the hand is preferable to s all other measures. If prostration is the 
cause, claret, 1 to 2 teaspoonfuls every five to ten minutes. If all 
else fails, styptics must be applied to the inner surface of the 
uterus, as ice, in small pieces the size of a walnut; or introduce 
liq. ferri sesqui-chlorid. by means of a cylindrical wad of cotton- 
wool soaked in it; or inject equal parts of iron and water with 
Braun's syringe. 

When stricture and irregular contraction are present, and the 
patient complains of severe after-pains, anti-spasmodics are best, 
as, pulv. ipec. comp., laudanum, an emetic, or a sinapism over the 
sacrum after the clots have been removed from the uterus. Ene- 
mata with 20 drops of laudanum, an emulsion of bitter almonds 
with 20 drops of extract of hyoscyamus, are of great service. 

When the uterus is firmly contracted and the genitals and 
vagina are not the seat of hemorrhage, it must arise from the 
cervix, and local styptics are required, as cold injections, made of 
cotton-wool soaked in solution of chloride of iron, passed into the 
cervix, and plugging the vagina with balls of cotton- wool rather 
than the colpeurynter. Manget squeezed the juice of half a lemon 
into the cervix with complete success. 

A. D. L. NAPIER, M. B., LONDON, 

(Obst. J. G. B. and I., Feb., 1877,) observes that we should have 
no fear of using iron injections, as the os is patulous, and the return 
of the fluid is certain. Absorption is not active, hence we need 
not fear pyemia. Brandy, beef-tea, and ergot are foremost as 
internal treatments. Ergot is greatly increased in its specific 
action by the addition of strychnia. 



252 COMPLICATIONS OF PARTURITION. 

H. OTIS HYATT, M. D., KINGSTON, N. C., 

(Obstet. Jour. Grt. Brit, and Ireland, Sept., 1877,) proposes the use 
of the condom, or, better, the toy balloon tied over the end of a 
Davidson syringe nozzle, and passed within the flaccid womb, and 
then distended by warm or cold water, thus pressing directly upon 
the mouths of the bleeding vessels. He has successfully employed 
it in a number of cases. He regards it as effectual in one or two 
minutes ; and harmless, as if it should burst it would only wash out 
the womb. 

A. V. MACAN, A. B., LONDON, 

(Obst. J. G. B. and L, July, 1876,) injects ether subcutaneously, 
say half a drachm, at once, and with the most remarkable results. 

LOMBE ATTHILL, M. D., 

Has had equally good results, using a drachm of ether. 

DR. M'CLINTOCK, OF LONDON, 

Regards this as a valuable acquisition to our resources, and one 
which has great advantages over transfusion. 

DR. BAILLY, OF PARIS, 

In secondary post-partum hemorrhage, (Archives de Tocologie, 
Nov., 1877,) nas use d the hot bath with great success. One had 
hemorrhage eighteen days after delivery. The uterus could be 
felt two fingers' breadths above the pubes. Spite of injections of 
iron and the use of ergot, the loss continued obstinately for ten 
days. After the first hot bath, the loss was much diminished; 
after the second, it was suspended. It recurred in thirty-six 
hours, but a third bath arrested it, and involution was rapidly 
completed. A similar case set in twenty-seven days after delivery. 
It was continuous and profuse. A hot bath of twenty minutes' 
duration entirely stopped the hemorrhage. He attributes the 
benefit to the relief of uterine congestion, consequent upon the 
dilatation of cutaneous capillaries, the resulting determination of 
blood to the surface, and diminished vascularity of deep-seated 
organs. The baths are of a temperature of 34 Centigrade, and 
the immersion from twenty to thirty minutes. 



PUERPERAL HEMORRHAGE. 253 

DR. KOEHLER, OF GERMANY, 

This writer [All. Med. Central- Zeitung % No. 1, 1879,) states that 
he has, for the last seven years, in cases of uterine hemorrhage, 
applied warm fomentations to the head, to prevent anemia of the 
brain, and also to the heart. Hot sand-bags are also very efficient, 
and the patients often will bear sand which is so hot that it can 
scarcely be touched with the hand. As soon as the fomentation 
or bag has been applied, consciousness is restored ; the pulse 
grows stronger; the patient herself states that she feels better, that 
the ringing in the ears has ceased, and that she likes the appliance. 
As soon as it becomes cooler, she wishes it to be renewed. Dr. 
Koehler has, he says, saved patients even in the most dangerous 
cases of hemorrhage, bysthis proceeding, by which the physician 
never loses time, as the fomentations may be watched and renewed 
by any one. 

. JAMES BRISBANE, M. D., OF LONDON, 

Uses per-chloride of iron by the " ready method ;" it acts like a 
charm. Nothing more is required than to carry a two ounce bot- 
tle of ordinary tincture of the chloride of iron. A piece of sponge 
is compressed in the palm of the hand, and the iron poured on it, 
and thus conveyed up to the bleeding surface of the uterus, there 
pressed and left. The blood coagulates, the womb contracts, and 
the danger is over. At the next visit, the sponge is found in the 
vagina, and no bad results follow. It is better than injections, no 
time is lost, and the objections of thrombosis, injecting air, etc., 
are obviated. 

PROF. KARL SCHROEDER, ERLANGEN. 

This author counsels the tampon or colpeurynter, etc.; as soon 
as the dilatation will allow it, a finger should be passed to one side 
when the placenta is lateral, and an effort made to turn by one foot. 
When the placenta is central, one cotyledon is to be separated 
from the side of the os, and then the foot sought for. One foot 
is to be brought down, and so on until the delivery is complete. 
It is, however, advisable to continue with the tampon until the 
head is firmly pressed against the bleeding surface, or until dilata- 
tion will allow of turning. It is always best for mother and child 
to turn as soon as practicable, and only to omit doing so when the 
head stops the bleeding. The forceps may be used if necessary. 



254 COMPLICATIONS OF PARTURITION. 

If the child is dead, the placenta may be separated entirely, and 
delivered before the child. 

Hemorrhage may also arise from the vessels of the cord, and 
the child is in great danger. Here the rupture of the membranes 
should be delayed as long as possible, and the rubber-bag used 
until dilatation will allow of immediate extraction. 

ALFRED MEADOWS, M. D., LONDON. 

Accidental hemorrhage is known by the blood being almost 
entirely liquor sanguinis. In placenta praevia, the vagina is filled 
with coagula. The treatment will be recumbent position, cool 
drinks, astringents, as the acetate of lead, two grains given in one- 
half a drachm of dilute acetic acid, to prevent its decomposition in 
the stomach, every four or six hours; or gallic acid; or sulphuric 
acid, as in the infus. rosae comp., or both combined, which 
is far more powerful than singly; opiates in large doses. If 
these fail, plug the vagina. Avoid this if possible, when the time 
is not full, as it is liable to bring on labor. The plug must be 
firm and the vagina completely filled. Its effects will be enhanced 
if, at the same time, a firm bandage is placed over the abdomen. 
The vagina must be full, but not distended. 

When the discharge is very great, with pain and pregnancy at 
full time, expedite delivery. 

In placenta praevia, act according to the necessities of the case ; 
plug and wait for dilatation, then turn and deliver. If there is not 
dilatation, and the loss is great, puncture the membranes, and 
secure dilatation with the rubber dilators, and deliver speedily. 
The separation of the placenta seems to be most safe. 

When due to retention of the placenta, introduce the hand and 
peel it off with the utmost carefulness. In doing this, keep the 
other hand on the fundus uteri, so as to steady the womb. Next 
guard against the evil effects of decomposition by syringing with 
antiseptics. When due to atony of the uterus, use ergot, cold, 
pressure and galvanism. These failing, introduce the hand to excite 
the womb to contract. 

When the womb relaxes after once contracting, support the pa- 
tient with brandy ; grasp the womb firmly, and by pressure cause 
it to expel its contents, or turn them out with the other hand. 
Irritate it by manipulation within and without. Ice may be intro- 
duced within the organ, or a cold douche thrown on the abdomen. 



PUERPERAL HEMORRHAGE. 255 

Electricity rarely fails to induce permanent contraction. Place 
one pole over the fundus and the other on the perineum. 

All failing, inject solution of perchloride of iron into the uterus, 
first clearing out all coagula. Remember the danger of this injec- 
tion, and only use it as a last resort. 

PROF. WM. LEISHMAN, M. D., GLASGOW, 

Epitomizes thus : The evacuation of the waters is best in partial 
placenta previa, and where the membranes can be reached, and 
where the foetus is immature. 

Ergot and oxytocics may be given, but it must be remembered 
that these and the above render turning more difficult. 

Plugging is called for, and may be applied in the vagina or in the 
os uteri ; it is a temporary expedient, and in turning is essential as 
a preliminary. 

Extraction of the placenta is not to be done unless the circum- 
stances are very exceptional, as when turning is impossible, and 
separation has failed. 

Separation of the placenta is more justifiable, but the operation 
of turning is that in which the majority place the greatest confi- 
dence. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

This author recommends the production of contraction by 
pressure by the hand ; the removal of any blood clots that may 
remain in the uterus ; ice in the vagina ; injection into the uterus 
of half an ounce of the solution of the sub-sulphate of iron, diluted 
with an equal measure of water; and internally administer thirty 
drops of the fluid extract of ergot with twenty drops of the tincture 
of mix vomica every half hour, until well assured that the uterus is 
well contracted. If the patient has suffered a severe shock from 
loss of blood, twenty drops of laudanum and alcoholic stimulants 
should be given, and repeated at short intervals until reaction is 
restored, and then give the ergot and nux vomica. 

If there be a portion of the placenta retained, the ergot and nux 
vomica should be administered as a precautionary measure. 

If the hemorrhage results from a uterine polypus, Dr. Barker 
recommends its removal with the vulsella forceps. If from lacera- 
tion of the vagina or vulva, involving varicose veins or arteries, he 
recommends ligation or such local measures as are demanded in 
hemorrhages. 



256 COMPLICATIONS OF PARTURITION. 

T. G. THOMAS, M. D., NEW YORK 

Urges {American Practitioner, May, 1877,) the induction of pre- 
mature labor in placenta prsevia. It is the only method by which 
the danger can be avoided. It is a rational and perfectly warrant- 
able means, and has no danger to be compared with that of non- 
interference. It removes the hazards incident to delay, and re- 
lieves the great anxiety of patients, friends and physicians. 

GEO. T. HARRISON, M. D., NEW YORK, 

Gives the resources thus (Am. Jour. Obstet., No 36, p. 576): 
They are enumerated in the order they are to be employed — (1) 
Friction, kneading and compression of the uterus. (2) Hypoder- 
mic injection of ergot above the symphysis pubis. (3) Injection 
of hot water at a temperature of at least 100 F. into the uterine 
cavity. (4) The injection of Churchill's or U. S. tincture of iodine 
into the uterus. 

Ergot, thus hypodermically used, he says, unfolds its peculiar 
power over the muscular tissue with a degree of promptness and 
certainty of which those who know of the action of the drug only 
through the other modes of administration can have no idea. 

He refers to intra-uterine injections of ergot in the following 
manner : Remove coagula ; then, with a Davidson syringe, wash 
out all blood with cold water, and quickly inject into the cavity 
f.Sss Squibb's fluid extract of ergot, with water f.Siv. The effect 
has invariably been to bring on promptly strong, permanent tonic 
contraction of the muscular fibres of the uterus. 

Dr. Strudwick has tried it in six cases of hemorrhage, and 
says it surpasses Monsel's styptic. 

He has never been disappointed in ergot thus applied, and con- 
fidently recommends its use to those who have never tried it. Its 
superiority over the iron treatment must be obvious to any intelli- 
gent practitioner, since the latter application is often followed by 
serious consequences, and is never used without grave apprehen- 
sions of serious results, whereas the ergot is perfectly harmless 
and unirritating. 

Some critic may say, the result obtained should be ascribed to 
removal of coagula and cold injections, etc. ; but such is not the 
case, since after trying all those measures repeatedly — with ergot 
by mouth and rectum — each time only bringing on slight trans- 



PUERPERAL HEMORRHAGE. 257 

ient contraction, until ergot was tried, with the unfailing success 
which always attends its use when thus applied. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

Urges preventive treatment in all cases. The hand should be kept 
upon the womb until the placenta is expelled, and continuous 
contraction kept up for at least half an hour after delivery, by 
grasping the contracted womb with the palm of the hand and pre- 
venting its relaxation. It is also good practice to give a full dose 
of ergot after the placenta has been delivered. When the previous 
history causes an expectation of hemorrhage, the ergot should be 
given, and preferably hypodermically, about 10 to 20 minutes 
before the labor is expecte,d to be concluded. Then any means 
should be taken to insure contraction of the organ, and it is 
advisable to rupture the membranes early, as soon as the os is 
dilated or dilatable, to insure stronger uterine action. Care should 
be had in all cases where the pulse is high some ten or fifteen: 
minutes after the birth of the child, as hemorrhage often follows.. 
Hence, never leave a patient until the pulse falls to the normal. 
After speaking of pressure, he alludes to another plan : pass the 
fingers of the right hand high up in the posterior cul-de-sac of the 
vagina, so as to reach the posterior surface of the uterus, while 
counter-pressure is exercised by the left hand through the abdo- 
men. The anterior and posterior walls are thus closely pressed, 
together. 

Brandy must not be relied upon. In bad cases it merely fills 
the stomach, and may be thrown up unaltered. It may bring on. 
intoxication, which is mistaken for coma of syncope, etc. 

A drachm of ether may be injected hypodermically in great 
exhaustion. Give fresh air, keep the head low down, so that syn- 
cope cannot occur. Empty the uterus of clots or other foreign, 
bodies. 

Intra-uterine injections of warm water, no° to 120 , are highly 
recommended. This succeeds after all the usual remedies fail, 
especially where the uterus contracts and relaxes. 

A distended bladder will often prevent contraction. Evacuate it 
with the catheter. 

Never plug the vagina. 

Compression of the abdominal aorta is a temporary expedient, and 
1 7 






2 $8 COMPLICATIONS OF PARTURITION. 

supplements other means, as also when there is great exhaustion, 
the firm bandaging of the extremities with the elastic bandage to 
retain the blood in the trunk, and lessen the likelihood to syn- 
cope. 

In the last extremity, inject the strong liquor of chloride of iron, 
diluted with six times its bulk of water, being very careful to ex- 
clude the air from the syringe. 

The secondary treatment will be opium as a restorative, 30 to 
40 drops of Battley's solution by the mouth or in enema, quiet, 
beef, essence, milk, eggs, etc., in small quantities given frequently. 
Stimulants as demanded. 

PROF. R. A. F. PENROSE, M. D., PHILADELPHIA. 

Saturates a cloth with common vinegar, and passes it into the 
uterine cavity, and squeezes it. In a paper read before the Ameri- 
can Gynaecological Society, he claims that this procedure rarely fails 
to stop the flow immediately. It can be easily obtained. It can 
be easily and instantly applied without apparatus. It has never 
failed in his practice. It is sufficiently irritating to excite the 
most sluggish uterus to contraction, and yet not so irritating as to 
be subsequently injurious. It is an admirable antiseptic. It acts 
upon the lining membrane of the uterus as an astringent. 

H. P. C. WILSON, M. D , BALTIMORE, 

Urges the introduction of the hand within the uterus, and raking 
the surface which has been occupied by the placenta with the 
finger-nails. He says that in one case no further hemorrhage 
occurred, though the uterus did not contract, and its mouth 
remained open for nearly an hour after this operation. 

LOMBE ATTHILL, M. D., OF DUBLIN. 

This author is convinced that there are cases where a powerful 
local hemostatic in the uterus is absolutely essential to save life. 
He states his conclusions formally : 

1. That cases of postpartum hemorrhage occur in which the 
injection of the perchloride of iron, or some similar styptic, is 
alone capable of arresting the hemorrhage. 

2. That the injection of such styptic does not necessarily 
increase the tendency which exists in such cases to the occurrence 
of pyemia, septicemia, or peritonitis. 



PUERPERAL HEMORRHAGE. 2$Q 

3. That this treatment is specially applicable to anemic patients. 

4. That while it should never be had recourse to unnecessarily, 
it should not, on the other hand, be delayed too long. 

In using the solution of the perchloride of iron, he carries out 
in the main the directions given by Dr. Barnes. He has not 
however, in any case injected more than six or eight ounces, 
sometimes as little as four ounces of the fluid. He also uses it 
somewhat stronger than Dr. B. does — namely, in the proportion of 
one part of the strong liquor, B. P., to two of water. The import- 
ant point in using it is to take care that the end of the tube is 
passed up to the fundus of the uterus, and that the fluid be injected 
slowly. 

GEORGE A, TYE, M. D., OF CANADA. 

In using the hot water in post-partum hemorrhage, this practi- 
tioner [Canada Lancet, Nov., 1879,) dissolves in it one ounce of 
alum to the pint. He has found this attended with less disadvan- 
tages than the tincture of the chloride of iron. In a comparison 
of the two, he states the following conclusions: 

1. That we possess two powerful topical remedies for post- 
partum hemorrhage. 

2. That the iron is the more powerful to control hemorrhage, 
but by far the more dangerous one. 

3. That hot water is nearly equal in hemostatic power, and with- 
out danger. 

4. That we are rarely justified in using the iron before the hot 
water has been tried. 

5. When the hot water fails, it is the duty of the accoucheur to 
use the iron. 

6. The hot water has these advantages over the iron; it can al- 
ways be procured; it washes away all clots, leaves the uterus 
clean, and therefore, no danger from thrombus or septicemia. 

7. Alum is a valuable addition to the hot water, securing two 
forces, viz : the contraction of the uterus and the coagulation of 
the blood. 

8. That we have not yet reached perfection in the treatment of 
the hemorrhage, and that abundant ground is open for observation 
and research. 

In a discussion of this measure, at one of the London medical 
societies recently, Dr. John Walters stated four conditions essen- 
tial to success: 



260 COMPLICATIONS OF PARTURITION. 

1. The uterus must be emptied completely. 

2. The temperature of the water must be from ioo° to no°. 

3. The tube must be passed to the fundus. 

4. A considerable quantity of water must be used. 

The advantages of warm water are that it is cleanly, always 
at hand, antiseptic, and perfectly safe. He drew three conclusions; 

1. Severe hemorrhages were controlled by warm water. 

2. Cold or ice, in conjunction, was useful. 

3. In some cases, perchloride of iron must still be used. 

RESUME OF REMEDIES. 

Acetum. Vinegar has a long-standing reputation in post-partum hemor- 
rhage. Dr. Davis {Obstetric Medicine, 1836,) recommended the 
intrauterine injection of one part of vinegar to two of water. 
It has recently been highly praised by Dr. Penrose, of Phila- 
delphia. (See psge 258.) 

Cannabis Indica was much esteemed by Dr A. Christison, but most later 
observers have failed to verify his statements. Dr. Wm. Don- 
ovan, however {Edinburgh Med. Jour., June, 1875), says in 
doses of gtt. xx. p. r. n., he never knew it to fail. 

Capsicum. A teaspoonful of tincture of capsicum will often prove the 
best of stimulants in atony. 

Chloralum, as at once a styptic and antiseptic, has been preferred for 
intra uterine injections by some writers. 

Ergota has been used in large doses by the mouth, in hypodermic injec- 
tion, and locally as an intra-uterine application. Dr. Lombe 
Atthill says that it is a most uncertain agent, and while most 
useful if administered some time before the occurrence of the 
hemorrhage, is, in his opinion, seldom of much value if given 
after it has set in. Ergot takes at least twenty minutes to act, 
and besides is often in these cases vomited. Injected hypoder- 
mically, it is capable of doing much good; but its. irritating 
properties when thus used, render this method of employing it 
not altogether unobjectionable. 

Erigeron Canadense, the "squaw-weed," has a popular reputation as a 
hemostatic in uterine hemorrhage. A teacupful of the infusion 
or five drops of the oil, may be given every half hour in light 
cases. 

Ether has been used in hypodermic injection and as spray to the hypogas- 
tric region. The former has been especially recommended by 
Prof. Von Hecker, of Munich, in conditions of collapse from 
hemorrhage. The chief point to be attended to in making the 
injection, is to pass the syringe well down in the subcutaneous 
cellular tissue ; otherwise troublesome abscesses may form at the 
seat of the injection. The quantity to be injected depends 
entirely on the pulse. Professor Von Hecker frequently injects 
from two to four drachms at short intervals. The effect is very 
transient, so that the injection may have to be repeated. 



PUERPERAL HEMORRHAGE. 26l 

Fcrri Chloridi Tinctura, strongly eulogized by Barnes, Atthill, Hicks, 
and others as an intra-uterine injection, has been severely con- 
demned by Dr. Snow Beck as dangerous. In certain desperate 
cases it seems the only resource which is efficient (see page 259). 
The tincture may be diluted, or used of full strength. The tube 
of the syringe should be carried to the fundus, and the contents 
gently injected ; or a sponge may be steeped in the solution and 
carried to die fundus. 

Fori Sulphas and Monsel's Solution have at times been used, and may 
have some advantages over the chloride. Dr. Wilson, of 
Baltimore, states that the sub sulphate should be combined with 
glycerine, as the simple solution acts as an irritant. Others use 
f 3 i j of Monsel's solution to water f.gvj, to wash out the uterus. 
It is sure to check the hemorrhage, but the sequelae may not be 
agreeable. 

Iodinii Tinctura has been used, some employing several drachms of the 
pure tincture, others diluting it in the proportion of f.3j to 
water f.^j. In a paper read before the Obstetrical Society of 
London, October, 1874. Dr. Trask recommends this article as 
an injection into the cavity of the uterus, in hemorrhage after 
delivery, as perfectly safe — at any rate, free from the evils 
incident to the employment of iron. It is an antiseptic, and is 
probably the surest of all means of counteracting a tendency to 
absorption of septic matter into the system after delivery. 

Ipecacuanha. In some cases a full dose of this drug, bringing on rapid 
emesis, causes strong contraction after inertia, and promptly 
checks the hemorrhage. 

Nitrite of J my I has been used by Dr. E. W. Kerr (Brit. Med. Jour., 
Nov. 1, 1869,) with excellent effect. Five minims were admin- 
istered through an inhaler. 

Plumbi Acetas. Dr. J. Workman, of Toronto {Canada Lancet, Jan., 
1878), urges acetate of lead in large doses, from y 2 a drachm 
to a drachm ; it will generally be found that in these large doses 
it acts as a moderate purgative within twenty-four hours; and, 
if it be desirable that, in order to avoid transformation, it should 
be expelled from the bowels in this way, it may be better to err 
on the safer side, which certainly is not its exhibition in small 
doses. In one case he gave 6 drachms in twelve hours. He 
quotes Dr. Daniel Clark and others of eminence, who give it in 
even larger doses, and with like good result. 

Viscum Album, the mistletoe, has been introduced as an agent in post- 
partum hemorrhage by Dr. W. H. Long, U. S. M. H. S. 
{Louisville Med. News, March, 1878). But as it requires 
''from twenty-five to fifty minutes " to produce uterine con- 
tractions, its efficiency is slight. 

general measures. 

Cold. This should never be neglected. Fanning the genitals, spinal 
ice-bags, injections of ice water, a lump of ice in the uterus, 
ether or rhigolene spray to the hypogastric region, spine or 



262 COMPLICATIONS OF PARTURITION. 

thighs, are some of the methods in which it may be used. A 
tumblerful of ice water flavored with brandy will sometimes act 
like magic, when given just after the second stage is completed. 

Compression of the Abdominal Aorta may be carried out in thin subjects 
with delicate abdominal parietes. 

Electricity and Galvanism have been found of decided advantage in some 
light cases, but cannot be depended on in severe ones. 

Heat is at times more energetic than cold. Chapman's spinal hot water 
bags have been spoken of for the purpose. Dr. Windebrand 
reported (Deutsche Med. Woch. June, 1876,) a desperate case 
where he threw into the uterus water at 120 F. by means of a 
uterine tube, which immediately caused a renewal of the pains, 
which, after an interval of five to ten minutes, and some eight 
or ten injections had been made in the meantime, ended in the 
expulsion of the whole of the contents of the uterus. Other 
cases have been reported by Atthill, Mann, etc. Dr. Koeh- 
ler (Gazeta Ckarska, No 8, 1878,) has obtained relief in the 
most desperate cases by applying very hot sand bags to the 
head and cardiac regions. They are particularly useful to pre- 
vent collapse, and do not interfere with other means. 

Mammary excitation, by applying the child, the mouth of the nurse or 
a cupping glass, to the mammae, will occasionally excite uterine 
contractions. 

Massage of the uterus by gentle and continued " hand kneading" is a 
simple and valuable plan to awaken the muscular contractility. 

Position is always of great value. "It is most important," observes Dr. 
J. H. Aveling (Influence of Posture on Women, 1879), "that 
every woman suffering from uterine hemorrhage should be im- 
mediately placed in a recumbent position with the hips raised as 
far above the level of the shoulders as can conveniently be 
effected." 

Pressure. "The value of pressure on the fundus," says Dr. Atthill, 
"can hardly be overestimated. It should be combined with 
friction." Mr. David Christie (British Medical Jorunal, 
June. 1878,) describes a method of arresting uterine hemor- 
rhage by fluid pressure. He introduces an elastic bag into the 
uterus, connected with a tube seven feet and a half in length, the 
free end of which, after the bag is filled, is placed in water at 
the proper height. Mr. Christie reasoned that, as a tube placed 
in an artery has a column of water raised seven and a half feet 
by the heart's action, so his method would effectually arrest any 
hemorrhage that could occur, and allow the womb to contract 
and relax without the pressure of the water being interfered 
with. 

Sinapisms to the extremities are among the means currently used, but are 
not very efficient. These are aimed to bring the blood to the 
limbs. With a somewhat similar idea, Dr. Moller, of Vienna, 
has recommended ( Wiener Med. Presse, No. 8, 1874,) applying 
the Esmarch bandage to the arms and legs. 

Transfusion has been growing in favor of recent years, in desperate cases 



PUERPERAL HEMORRHAGE. 26 



of bleeding. The forms of transfusion most employed and 
attended with the best results are : 

1. Transfusion with defibrinated blood. 

2. Mediate transfusion with pure blood. 

3. Immediate transfusion from "vein to vein." 

4. Immediate transfusion from "artery to vein." 

The first and third methods are most generally adopted — 
the danger of clots is avoided. The second is generally aban- 
doned, as leading to embolism, etc. Instead of blood, Dr. J. W. 
Howe (N. Y. Med. Jour., 1875,) recommended goat's milk; 
and Dr. T. G. Thomas and others have successfully employed 
cow's milk. The conclusions reached by Dr. Thomas are em- 
braced iii the following propositions : 

1. Injection of milk into the circulation, in place of blood, is 
a perfectly feasible, safe, and legitimate procedure. 

2. In this procedure, none but healthy milk, drawn from the 
udder of the cow^ within a few minutes of its introduction into 
the vein, should be employed. 

3. A glass funnel, with a rubber tube and a suitable pipe 
attached, is much better and safer than a more elaborate ap- 
paratus. 

4. Intra- venous injection of milk is an infinitely easier opera- 
tion to perform than transfusion of blood. 

5. Intra-venous injection of milk, like that of blood, is com- 
monly followed by a chill and rapid rise of temperature ; but 
these symptoms soon subside, and are replaced by a great im- 
provement in the general condition of the patient 



PUERPERAL ECLAMPSIA. 

For many valuable points on the prophylaxis of this complica- 
tion, see Albuminuria. 

PROF. KARL SCHROEDER, ERLANGEN. 

There are two methods of treatment, the abstraction of blood, or 
the use of narcotics. Venesection has often given favorable and 
exceedingly rapid results, but frequently the attacks have soon 
recurred, and then taken a more unfavorable course. A more 
rational treatment would be the paralysis of the activity of the 
voluntary muscles, and this can be done by narcotics ; thus the 
convulsions are certainly checked for hours, and the blood is not 
deteriorated. Scheinesson has shown by experiment that chloro- 
form diminishes the blood pressure in the arterial system. Experi- 
ence is decidedly in favor of this treatment; but to be effectual, the 
narcosis must be absolute, so that the voluntary muscles no longer 
contract. As long as an eyelid quivers, another dose is required. 
Chloroform will do this, but as it must be maintained, morphia is 
better; or if haste is necessary, chloroform first, and replace it by 
subcutaneous injections of morphia. Chloral is also of great- 
advantage, and may also be used subcutaneously ; or an enema of 
mucilage of starch, y 2 cupful with 32 grains chloral in an ounce 
of decoction of althaea. 

Venesection may safely be omitted. No obstetric manipulation 
is required for the safety of the mother, but labor may be hastened 
to save the child. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

There are good grounds for believing that blood-letting is of only 
temporary use, and that it may even increase the convulsive ten- 
dency. In special cases, as where there is evidence of great cere- 
bral congestion and vascular tension, as a livid face, a full-bounding 
pulse, and strong carotid pulsation, the patient a strong, healthy 
woman, it may be employed. Even here, a single bleeding is all 
that is ever likely to be of service. 

As a temporary expedient, the carotids may be compressed. 

Purgatives to remove any irritant matter lodged in the intestinal 
tract, may act well ; as the comp. jalap powder in a full dose, or a 

(264) 



PUERPERAL ECLAMPSIA. 265 

drop of croton oil, or a quarter of a grain of elaterium may be 
placed on the back of the tongue. 

Chloroform may be used to control or ward off the paroxysm. 
It is advisable, however, to have a remedy more continuous in its 
action, and requiring less personal supervision. Chloral is decid- 
edly this remedy, and, in combination with bromide of potassium, 
in the proportion of 20 grains of the former to half a drachm of 
the latter, repeated at intervals of from four to six hours. 

Dr. Harris, the American editor of Playfair, has used bromide 
of sodium and chloral with good effect at shorter intervals, and 
the chloral in doses of 10 to 15 grains. 

If the patient cannot swallow, it may be given by enema. The 
remarkable influence of bromide of potassium in controlling the 
eclampsia of infants, seems to be an indication of its use here. 

Morphia may be given subcutaneously in the dose of J^ of a 
grain, repeated in a few hours so as to keep up its effect. 

Acetic and benzoic acid, as antidotes to uremic poisoning, are 
too uncertain. 

During the paroxysm, prevent the patient from injuring herself, 
especially biting her tongue, by placing something between her 
teeth. 

As to the delivery, adopt that course least likely to irritate. If 
the fits seem to be induced and kept up by the pressure of the 
fetus, and the head be within reach, apply the forceps, or even 
resort to craniotomy. Otherwise, leave the case to nature. 



PROF. FORDYCE BARKER, M. D., NEW YORK. 

This physician places among the exciting causes of puerperal 
convulsions, anemia, albuminuria, uremia, indigestion, constipa- 
tion, retention of urine, excessive distention of the uterus, reflex 
pains, or moral shocks. 

As a prophylactic, he removes as speedily, and effectually as pos- 
sible these exciting causes by appropriate treatment. If at the 
advent of labor, convulsions be threatened, he abstracts from the 
patient a moderate amount of blood, not enough to weaken her, 
but sufficient to restore the equilibrium of the circulation; he does 
not permit the bladder to become distended. If the patient is irri- 
table, restless, complains loudly of little annoyances, and is sleep- 
less, he tranquilizes her by a moderate opiate. 



266 COMPLICATIONS OF PARTURITION. 

When the convulsion has occurred, he says, bleed at once, then 
give a brisk cathartic, as : 

264. I£. Hydrarg. chloridi mitis, gr.x 

Pulv. jalapae, gr.xx M. 

Ft. pulv., No. j. Sig. — Take at once. 

But if she be comatose, he mixes a quarter of a grain of elate- 
rium with a third of a teaspoonful of butter, and places it upon the 
back of the tongue. This is to be repeated every half hour until 
active catharsis. To arrest and prevent convulsions, administer 
chloroform by inhalation. 

Having overcome the immediate danger from convulsions by 
the means stated, he administers a full dose of morphia hypoder- 
mically. 

DR. CHARLES, OF BELGIUM, 

In the Memoirs of the Belgian Academy of Medicine , 1876, sums 
up as follows the treatment of eclampsia in his memoir on the 
convulsions of parturient women, which was crowned by the 
Belgian Academy of Medicine : 

1. Mechanical eclampsia from the sixth to the ninth month : 
(a) Bleeding, if the case be urgent, or if there be true or apparent 
plethora ; (b) drastics, in all cases, which may be more or less 
replaced by diaphoresis ; (c) chloroform when the fits are about to 
commence, and during the clonic convulsions ; (d) chloral in the 
intervals of the attacks, as an injection to beneficially fill the place 
of narcotics ; any antispasmodic, such as bromide of potassium, 
may be added to it ; (e) to finish the delivery, if possible, bring on 
labor, if the fits do not show signs of disappearing ; to bring on 
forced delivery in very serious cases. 

2. Reflex eclampsia before six months gestation, and after deliv- 
ery : (a) Bleeding is but very rarely indicated ; (b) purgatives 
are always somewhat useful; (c) chloroform, chloral, etc., should 
be continued as in mechanical eclampsia, and antispasmodics 
should not be neglected. 

3. Toxic eclampsia : Fulfill the symptomatic indications ; gen- 
eral or local bleedings to combat congestion of the brain and 
spinal cord when it is very marked ; cold applications to the head, 
purgatives, diaphoretics, baths, revulsives, narcotics, anaesthetics, 
etc. 



PUERPERAL ECLAMPSIA. 267 

M. DUNCAN, M. D. 

Comes to the conclusion (Practitioner, April, 1875, ) that Bright's 
disease as a cause is overestimated. A temporary appearance of 
albumen in the urine is no certain indication of Bright's disease. 
The treatment is to empty the uterus ; but, if labor is only com- 
mencing, it should only be done if the symptoms are desperate; 
with severe and frequent fits, cyanosis and profound coma, 
move the bowels, draw off the urine ; tide over the crisis with 
bleeding ; chloroform and chloral are useful ; chloroform must be 
used with great caution where cyanosis is great. 

PROF. F. WINCKEL, M. D., ROSTOCK, GERMANY, 

Says venesection is very rarely required. Only the most imminent 
danger will be an indication for resorting to this measure. Gener- 
ally severe attacks become milder when profuse perspiration is 
established after the delivery. Excite copious evacuations by 
drastics, as jalap, aloes, ext. colocynth, and enemata of vinegar and 
salt. As diuretics, tartaric acid, lemon juice, and flower of benzoin 
may be given. During the attack, chloroform may be used. If 
this be of no avail, strong doses of opium are of great value. 
Hypodermic injections, if the patient.be unable to swallow. If 
there is great central congestion, leeches may be applied to the 
forehead or behind the ear. Cold compresses, ice bags, sinapisms 
to the back of the neck, or even cold irrigation of the head, 
are advisable. Afterwards, stimulants to prevent collapse when 
threatened, tonics and nourishment for hydremia. 

WM. BERRY, M. R. C S., EDINBURGH. 

For the treatment we have three periods : 

During pregnancy, when we must employ purgatives, bleeding, 
chloroform, and chloral. 

Dimng labor, chloroform and delivery. 

After delivery, chloral and bromide of potassium. A single 
dose of 30 grains each of chloral and bromide will usually prevent 
a recurrence of the convulsion, and produce quiet sleep {Obst. 
Jonr. Grt. Brit, and Ireland, April, 1878). 

ANGUS MACDONALD, M. D., EDINBURGH, 

{Obst. Jonr. G. B. and I., Aug., 1876), regards as the most im- 
portant, sedatives and anaesthetics, and especially chloral, chloro- 



2 58 COMPLICATIONS OF PARTURITION. 

form, ether, and bromide of potassium. He trusts chiefly to 
chloral, giving it in doses of 25 grains every six hours, so long as 
the fits continue or threaten. He believes that it acts to dilate the 
arterioles, thus favoring the disappearance of anemia in the brain ; 
acts as a sedative to the nervous system generally; allays muscu- 
lar irritability and spasm, and thus tends to obviate cerebral con- 
gestions and extravasations. 

AFTER LABOR. 
A. E. AUST- LAWRENCE, M. D., BRISTOL, ENGLAND, 

(Obst. Jour. G. B. and I., Oct., 1876), feeds carefully on milk diet 
for the first three or four days. Robust women who have eaten 
well up to confinement, require an aperient within 48 or even 24 
hours after confinement. He prefers : 

265. fy.. Hydrarg. chlorid. mit. 

Pulv. rhei, aa gr.ij 

Ext. belladon., 

Ext. opii, aa gr}(. M. 

For one pill, to be repeated every 6 or 8 hours till the bowels act ; gen- 
erally three are required. 

He urges ergot for the first week or two, if the uterus does not 
involute as it should. 

H. B. WHITE, M. D., BROOKLN, N. Y., 

Employed jaborandi in the case of a primipara at full term, highly 
anasarcous and urine very scant. The drug was given in infusion, 
one drachm of the leaves being used and divided into three doses 
at short intervals. After the first dose, profuse sweating and 
salivation ensued. There were three convulsions prior to, and 
several after delivery. The article was continued for three days, 
drenching the patient in perspiration. She completely recovered. 

PROF. OTTO SPIEGELBERG, BRESLAU. 

This writer (Trans. Am. Gyn. Soc, Vol. II.,) states that the 
treatment must be directed to effect three objects : 

1. The renal secretion must be restored. 

2. The arterial pressure must be diminished. 

3. Irritation of the nerve centers must be reduced. 

These results are most easily attained by (1) venesection; (2) 
narcotics, and (3) if the patient be in labor, by its speedy comple- 
tion. 



PUERPERAL ECLAMPSIA. 269 

In the treatment of true eclampsia he places venesection first. 
As soon as the patient is seen, let the brachial vein be opened 
and from six to sixteen ounces of blood be taken ; and this be 
repeated unless its effects are decisive. In mere eclamptiform 
attacks, bleeding may be omitted. Narcotics should be adminis- 
tered soon after venesection. Among them, chloroform is the most 
advisable. The inhalation must be guarded, and only take place 
when the aura of another attack is observed. Its administration 
may be combined with that of morphia or chloral; the former sub- 
cutaneously, the latter by the rectum ; of morphia gr. 1 /£ % of chloral 
gr. xliv, are sufficient doses to begin with. When there is coma, 
cold applications to the head are useful. In the paralytic stage, 
stimulants must be resorted to. Diuretics are useful as after- 
treatment during convalescence. 



RESUME OF REMEDIES. 

Aconitum has been used to reduce the arterial pressure. It is highly 
praised by Phillips. 

Belladonna is recommended by some writers as a sedative to the nervous 
system in these cases. 

Benzoicum Acidi/m, as a diuretic, is valued as a prophylactic and to hasten 
convalescence. 

Chloral Hydras acts as an anaesthetic, is claimed to be similar to chloro- 
form in its effects, to allay irritation of nerve centres, and to 
have a decided effect in controlling convulsions from whatever 
cause. It thus relieves the physician of the difficulty of decid- 
ing whether the cause be plethora or anemia, whether to bleed 
or not. Bat, like bleeding, it is accused of producing anemia. 
It may be conveniently given by the rectum in an enema hold- 
ing in solution gr.xxx-lx. Dr. Delauny, in a prize thesis, 
1879, says that statistics show that puerperal convulsions treated 
by revulsives and antispasmodics show 50 per cent, of mortality, 
by blood-letting 24 per cent., and by chloral 13 per cent. 

Chlorofor?n is acknowledged by all authorities to be of the greatest value 
either with or without venesection. For particulars as to its 
administration, see page 269. 

faborandi and Pilocarpin have both been advocated for their diaphoretic 
effects by Massmann, Tehling, and others {Cent. Blatt. fiir 
Gyn., 1878 . The modus operandi is attempted to be explained 
on the Fraube-Rosenstein theory of the convulsions. It is 
argued that the salivation and perspiration induced by the 
jaborandi or its alkaloid, relieve the excessive vascular tension. 
Two drachms of the fluid extract of jaborandi may be thrown 
into the rectum. 

Opium and Morphia. These are invaluable narcotics in this disease. 



2/0 COMPLICATIONS OF PARTURITION. 

They are best administered, opium by the rectum, morphia 
hypodermically. In sthenic cases, they should promptly follow 
venesection. 

Potassii Bromidum is excellent as a prophylactic, gr.x, three to six times 
daily. In the attack, it may be advantageously administered 
between the seizures combined with chloral, of each. 3ss. 

Sodii Bromidum acts similarly to the potassic salt, and may be used in its 
place. 

Veratrum Viride has been much discussed as an aterial sedative. Some 
practitioners claim that it entirely does away with the need of 
the lancet. It maybe given in hypodermic injection of gtt.v-x 
of the fluid extract; or by the mouth, in doses of gtt.v-xxx, 
repeated as required. If the pulse is full and above 80, give 
the doses fearlessly {Trans. Am. Med. Assoc, 1876, p 240). 
An ounce has been administered in twenty-four hours with 
success. Others fear the depressing character of this remedy, 
and do not favor it. 

GENERAL MEASURES. 

Cold, in the form of ice to the head, spinal ice bags, etc., are valuable in 
states of coma. 

Diaphoresis, in order to produce a derivative effect and relieve the 
kidneys, has been attempted, both by means of drugs, as pilo- 
carpi, and by Jacquet, by enveloping the body in wet sheets 
wrung out in quite hot water. This can only be relied upon in 
mild cases, and rather as a prophylactic. 

Purgatives diminish arterial attention, draw congestion from the renal 
regions, and are a rational mode of treatment. A full dose of 
calomel and jalap maybe given if the patient is able to swallow; 
otherwise a drop of croton oil may be applied to the back of the 
tongue. In both cases an enema of castor oil and oil of 
turpentine, one tablespoonful of each in chamomile tea, should 
be thrown up the rectum (Spiegelberg). 

Venesection is, in sthenic cases of true eclampsia, the most valuable of all 
remedial measures. See p. 264. 



PUERPERAL MANIA. 

A. H. KUNST, M. D., WESTON, W. VA., 

In a paper read before the State Medical Society, gives the treat- 
ment as follows : His belief is that the tendency in such cases is 
towards exhaustion, hence depleting measures must be regarded 
with great circumspection; rarely is venesection justifiable. At 
the onset, if the secretions are locked up, a dose or two of calomel 
or blue mass, and warming laxatives, may be given according to 
circumstances, with great care to prevent a drain. If there be 
increased heat of the scalp, apply cold to the head. A warm bath 
in the evening will be useful and soothing, and promote sleep. 
The best hypnotic is a combination of chloral and bromide of 
potassium. Symptoms may, however, indicate hyoscyamus, 
conium, camphor, monobromated camphor, opiates, etc. Tran- 
quillity should be invited and encouraged by the attentions of a 
trained nurse, and all interference prohibited. Husband the 
strength, and, if necessary, use the camisole to restrain too con- 
stant movements. Diet should be nutritious and generous, and 
easy of digestion. Iron, quinine, phosphorus, etc., should be 
employed as indicated. If acute delirium occur, and she refuses 
food, use the oesophagus tube, and inject twice daily beef tea, and 
milk, and eggs alternately. 

The moral management is important, and she should be guarded 
against self-injury. Generally, the wiser plan is to remove her 
from her familiar surroundings, to change the train of ideas. 
Interviews with husband and friends should be restricted. Often 
she regards them as her enemies, and their visits add to the 
trouble. Exercise in the open air, with some light, congenial 
employment, is of great value. Convalescence should be aided by 
a few weeks at an agreeable resort, or pleasure- traveling. 

S. PUTNAM, M. D., MONTPELIER, VT., 

Says, in the Transactions of the Vermont State Medical Society, 
1879: 

First learn betimes the vulnerable points and tendencies of 
patients, and regulate their hygiene and medication accordingly. 
Should a latent albuminuria be found, let the patient live upon 

(271) 






2/2 COMPLICATIONS OF PARTURITION. 

milk diet; use the warm sitz bath at night, followed by abundant 
frictions to the back and limbs. In the morning, cold or tepid 
sponging, with friction, to be followed by walking, or carriage 
exercises. At lying-in, avoid as far as possible the causes of 
anemia, prostration, irritation and excitement. 

Should the patient be unable to sleep, make the conditions the 
most favorable to secure that result, and if sleep does not occur, 
use chloral, morphia and camphor, or whisky in quantities ordi- 
narily adequate to produce that effect, and we shall seldom have 
puerperal mania to treat. But should a threatening case explode, 
notwithstanding your care, perhaps a cathartic is needed, espe- 
cially if constipation exists, after which a more efficient use of 
anodynes, stimulants and tonics may succeed. Should they not, 
and the delirium be violent, aconite, veratrum or digitalis might 
be used, oreven anaesthetics. When uremic delirium or stupor is 
evident, use ten grains nitrate of potassa, one drachm nitrous ether, 
and five drops of dilute nitric acid in water, every four hours ; or 
instead, when insomnia persists, ten or fifteen grains bromide 
potassium every two hours, alternately with twenty drops tinctura 
ferri chloridi. Meanwhile, nutrients, stimulants and tonics, are to 
be given as needed. 

PROF. WM. LEISHMAN, M. D., GLASGOW. 

We can scarcely doubt that when there are indications of cere- 
bral disturbance, much may be done to ward off an attack, particu- 
larly where there is a hereditary taint, or where insanity has been 
present at previous confinements. 

It must be remembered that it is essentially a disease of debility, 
and hence blood-letting must be used, if at all, with very great 
caution, for we may thus precipitate a fatal result. It should only 
be used in actual phrenitis. 

Gastro-intestinal disturbance will require from the first prompt 
attention. Relieve the overloaded bowels, and keep them cleansed. 
Aloetic purgatives are very appropriate. Where the powers are 
not low, and there is a foul tongue, offensive breath, a yellow eye, 
an emetic of ipecacuanha may be given. Gooch believed this, 
and most modern writers agree. But, of course, this is contra- 
indicated when the face is pale, the skin cold, the pulse quick and 
weak. When much vascular excitement presents, cold to the 
head, or, even better, laving the forehead and temples with warm 



PUERPERAL MANIA. 2/3 

water, after which there is a refreshing coolness, may produce the 
desired effect. Tartar emetic very guardedly, or tincture of 
aconite, or of veratrum viride, are useful. 

The nervous sedatives are most important, and at the head of 
the list is opium, the sheet anchor. It must be given in very 
large doses. If there is difficulty in giving it, introduce a supposi- 
tory into the rectum, of one or two grains of morphia. Remem- 
ber that Tuke says opium or other narcotics are not to be used in 
acute mania. Chloroform has been employed beneficially ; the 
patient being placed fully under its effect, and so kept for a sea- 
son. Hyoscyamus, with ether or ammonia, and Indian hemp, have 
been used for the same purpose. Gooch's favorite was camphor. 
Chloral has now superseded opium, and is a most valuable article. 
The warm bath is an excellent sedative, and may succeed in the 
failure of drugs. Procure sleep, and the patient may at once re- 
cover. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

Maintain the strength of the patient, calm the excitement, rest 
the disturbed brain. Over active measures, as bleeding, blistering 
the shaven scalp, and the like, are distinctly contra-indicated. 

Abundance of nourishment comes next. Give solid food prin- 
cipally, reserving beef-tea and brandy later. Food must be given 
forcibly, if necessary. 

Stimulants increase the excitement, and are only useful in 
melancholia. 

Keep the bowels well cleansed. 

Procure sleep; nothing is so valuable as chloral, alone or in 
combination with bromide of potassium; 15 to 30 grains at bed- 
time rarely fails to procure sleep ; give this in an enema, if the 
patient will not swallow. 

Opiates are apt to do more harm than good. 

Blandford, on this point, says he believes opium never does 
good, and may do great harm. This applies equally, whether by 
the mouth or hypodermically. Often, after an opium sleep, the 
patient quickly rouses, and all is worse than before. In melan- 
cholia, in moderate doses, it may be given with advantage. 

The prolonged use of the warm bath, say at 90 , for half an 
hour, has acted well as a sedative. The wet pack is equally good,, 
and is more readily applied in refractory cases. 
18 



274 COMPLICATIONS OF PARTURITION. 

ALFRED MEADOWS, M. D., LONDON, 

Takes almost precisely the same ground. Remove all supposed 
sources of irritation ; quiet the nervous system ; support the 
strength. Oppose constipation with 20 or 30 grains of jalap 
powder and two to five grains of calomel, followed by saline 
aperients. Rigby advised antimony with calomel and ipecacuanha, 
as too speedy to depress, and acting as a rapid purge ; it acts, she 
falls asleep, perspires freely, and wakes greatly refreshed. As a 
rule, eschew opiates, they increase the irritability and favor cere- 
bral congestion. Chloral may be given in doses of 20 to 60 
grains, induces sleep without excitement or depression ; henbane 
and chloroform are of great service. White hellebore has been 
recommended, and Indian hemp also. Hydrocyanic acid in doses 
of 5 minims of the dilute acid, every four hours, has been found of 
great value, 

Vigilance must be great. Support with beef tea, wines, etc. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

Bleeding is useless, even injurious, as are vascular sedatives, 
except where there is also a latent local inflammation. Laxatives 
and emetics should never be given, except when positively re- 
quired. 

Insomnia, a striking feature, would suggest opium, but it will 
not, in any doses, cut short an attack, but may be of service where 
there is latent pelvic peritonitis. 

Allay brain excitement by restoring exhausted nerve power ; 
improve the nutrition of the brain by easily-assimilated food. 
Tonics are of great service, as tinct. of chloride of iron, chlorate of 
potassa, and the sulphate of berberina. The latter is preferable to 
quinine, as it has much less tendency to induce cerebral con- 
gestion. 

Induce sleep. Neither opium nor bromide of potassium will, as 
a general rule, do this. Chloroform also has disappointed nearly 
all. Chloral is of immense value; it does not interfere with any 
of the organic functions, is not followed by any unpleasant second- 
ary effects like opium, and never fails to produce sleep. This is 
prolonged for hours, and if interrupted, the patient falls asleep 
again without a renewal. It is best given in doses of 15 or 20 
grains well diluted, and repeated every two hours till the effect is 
produced. 



PUERPERAL MANIA. 275 

Combat all complications. Give laxatives for constipation, 
diuretics for deficient renal secretion. If cerebral erethism arise, 
shown by the flushed face and red eyes, give bromide of potassium, 
20 to 30 grains every six hours; but at night, for sleep, suspend 
this and give chloral. Watch for local inflammations, and employ 
appropriate remedies. 

In puerperal mania accompanied with high fever, restlessness, 
head symptoms and scanty secretion of milk, aconite acts speedily 
and markedly if given soon after the chill (Phillips.) 

When the delirium is wild and furious, but intermittent, with 
scanty secretion of milk, etc., stramonium is useful. The nervous 
system is relieved, the flow of milk renewed, and sleep restored. 
From a quarter to a half grain of the extract in 10-20 minims of 
the tincture maybe given every three or four hours until relief is 
obtained. The lochia, etc., should be watched, and the patient's 
powers sustained by nutrition and stimulation, (Phillips.) 

In puerperal hypochondriasis, Sir Jas. Y. Simpson, after failure 
with many remedies, used tincture of cimicifuga, fifty drops a day. 
In eight or ten days, the change for the better was marvelous, and 
the patient was completely restored to her former health and 
spirits. 

Prof. Bartholow also speaks of its value. 



PUERPERAL FEVER (PUERPERAL SEPTICEMIA. 
PUERPERAL PYEMIA). 

JAS. G. GLOVER, M. D., LONDON. 

In the Lancet, Feb. I, 1878, includes under the term "puerperal 
pyrexia," all cases of high temperature not associated with obvi- 
ous external inflammation as in the breast, or with obvious infec- 
tion from the common infectious diseases. Presumably the local 
lesion is uterine or peri-uterine, for there is almost always more or 
less pain in and tenderness over some part of the uterus, with a 
good deal of abdominal distention. There is also generally a quick 
pulse, and the thermometer, which is an invaluable guide in such 
cases, shows a high temperature. In no case has he seen suppu- 
ration, and the patient has got well gradually. 

He sums up the treatment : First, a dose of quinine and iron 
every three or four hours. The following is a good form in which 
to give these : 

266. Ify. Ouinise sulphatis, gr.ij 

Ferri chlor. tinct., 

Sp. chloroformi, aa nix 
Syrupi simp., f.3ss 

Aquae destil., f.§j. M. 

For one dose. 

Secondly, a dose of opium every three, four, six, or eight hours, 
according to the pain, without ipecacuanha, which may set up 
sickness, and without calomel, which may set up unnecessary irri- 
tation of the bowels. The dose of opium, say half a grain, is best 
given in a small pill. Thirdly, a large linseed or bran poultice 
over the stomach, repeated every three or four hours. A little 
laudanum in it often adds much to its soothing effect. Fourthly, 
and specially, vaginal injections, at least twice a day, of warm 
water with a little Condy's fluid in it. The diet should consist 
of good beef-tea or chicken-broth, with generally a small regulated 
allowance of brandy, a dessert-spoonful every three or four hours. 
Sometimes the brandy is best given with arrowroot. 

HUGH MILLER, M. D., OF GLASGOW. 

Excessive and Septic Lochial Discharge. This teacher, in a clin- 
ical lecture, reported in the Edinburgh Medical Journal, Nov., 

(276) 



PUERPERAL FEVER. 2/7 

1878, recommends the following prescription in cases in which 
there is an excessive discharge, accompanied by a relaxed condi- 
tion of the uterus. He administers 5j. doses of liquid extract of 
ergot, repeated every three or four hours, and 

267. $. Ouiniae sulph., 3ss 

Acidi hydrobromici, 3 v j 

Aquam, ad §ij. 

Dose, teaspoonful in water three times a day. 

By this method large doses of quinine may be given without caus- 
ing headache. 

In septic cases Dr. Miller advises the employment of sulplw- 
carbolate of potassa, in the form of powders, in doses of 10-15 
grains internally three times a day. When the discharge is sus- 
pended, the treatment consists of turpentine stupes applied over 
the lower part of the abdomen, with the addition of warm moist 
cloths, or of sponges pressed out of hot water, and applied to the 
external parts. In special cases, which require an antiseptic plan 
of treatment, Dr. Miller makes use of a solution of thymol, 1 
part to 500 parts of water, or, better, three grains of thymol to 
an ounce of Eau de Cologne. This mixture, which has a pleasant 
and rather refreshing odor, is simply sprinkled over the napkins 
before they are used. In severe cases, with a putrid odor, a solu- 
tion of permanganate of pota ss a, injected with Higginson's syringe, 
provided with a vaginal portion, is made use of; the injection of 
the fluid is continued till it returns unaltered in color. In all 
cases where the discharge is excessive, tincture of arnica is em- 
ployed ; the tincture is used in the proportion of one teaspoonful 
to a cupful of water ; it acts as a mild astringent and disinfectant. 

PROF. FORDYCE BARKER, M. D., NEW YORK 

This author has an exalted opinion of veratmm viride in this 
disease. He however recommends small doses, and the effects to 
be carefully watched. If the remedy produces symptoms of de- 
pression, these symptoms have been readily dissipated by brandy, 
whisky, or carbonate of ammonium. The veratrum viride should 
not be discontinued too early, as its premature withdrawal may 
be attended with renewal of the symptoms. He usually com- 
mences by giving five drops every hour, and gradually increasing 
the dose, if there be not a perceptible impression upon the pulse 
after giving two or three doses. After the pulse is reduced, it is 



2^8 COMPLICATIONS OF PARTURITION. 

thus maintained by administering two, three or four drops every 
second hour. 

It is also very important in this disease to allay pain, quiet ner- 
vous irritation, and secure sleep. These ends are best secured by 
opiates. He prefers Magendie's solution of morphia by the mouth, 
if the stomach is not irritable, but hypodermically, if there be nau- 
sea and vomiting. 

The next indication is to reduce fever. Quinine, mineral acids, 
cold sponging, alcohol, and appropriate nutrition, are the antipy- 
retics upon which the medical profession now relies. Of the mineral 
acids, our author prefers phosphoric acid. He believes that it allays 
nervous irritability and that it acts specifically as a tonic. He adds a 
teaspoonful of the dilute acid to a tumblerful of water, flavored with 
the syrup of orange peel. If the patient be disinclined to drink, 
he has sometimes substituted ten to fifteen drops of dilute sulphu- 
ric acid every two or three hours. The treatment of pyemia 
must be governed to a great extent by the therapeutical indica- 
tions of its associated diseases. Prof. B. regards quinine and alco- 
hol as the two great remedies in the constitutional treatment of 
this disease. He prescribes ten to fifteen grains of quinine in the 
morning, and from fifteen to twenty at night. If from idiosyncrasy 
there is an intolerance of this agent, he combines it with from ten 
to fifteen grains of the bromide of potassium. This counteracts 
the unpleasant cerebral symptoms which sometimes occur. He has 
never seen quinine produce paralysis of the motor power of the heart. 
He thinks a free use of stimulants obviates this danger. These 
he pushes to a degree of tolerance. To procure rest he advises 
an opiate at bedtime. Food the most nourishing and the most 
easily digested should be urged upon the patient, and skill should 
be used to make it tempting and palatable. If the urine become 
scanty, bloody and albuminous, he orders dry cups over the kid- 
neys, the free use of diluent drinks, and the tincture of the chloride 
of iron. The latter is very useful in conjunction with the chlorate 
of potassium when there are very profuse discharges of pus from 
external abscesses. He esteems the following combination : 

268. I£. Tinct. ferri chloridi, L3SS 

Aquae purse, f.§ijss 

Potassii chloratis, §ss 

Syr. aurant cort., 

Glycerini puri, aa f.^ij. M. 

Sig.— Tablespoonful in a wineglassful of sugar and water four times 
a day. 



PUERPERAL FEVER. 279 

SEPTICEMIA. 
PROF. W. S. PLAYFAIR, M. D., LONDON, 

Regards the indications: to discover, if possible, the poison, in the 
hope of arresting further septic absorption ; to keep the patient 
alive until the effect of the poison has worn off; and to treat any 
local complications that may arise. Antiseptic injections must be 
employed at least twice a day. He employs Higginson's syringe 
with a long vaginal pipe attached. He prefers the alternate use of 
Condy's fluid largely diluted, and the tincture of iodine. The 
washing should be thorough, and by the physician himself. Food 
and stimulants to keep up the powers. Not more than one or two 
hours to elapse without nutriment of some kind. In moderate 
cases a tablespoonful of brandy or whisky every four hours ; but 
when the pulse is rapid and thready, there is low delirium, 
tympanites or sweating, indicating great exhaustion, give them in 
larger quantities and at shorter intervals. In severe cases eight to 
twelve ounces, or even more, may be given in twenty-four hours 
with benefit. Never bleed. 

Give medicines to lessen the force of the circulation without ex- 
hausting, and to diminish the temperature. Tinct. of aconite is 
most valuable. Give a single drop every half hour, increasing the 
interval according to the effect. Generally, after four or five 
doses the pulse falls, and then a few doses every two hours will 
suffice. Watch it, and stop if the pulse becomes too weak, or in- 
termits. 

To reduce the temperature, give quinine ten to twenty grains 
morning and evening. The head and other unpleasant symp- 
toms may be lessened by the addition of ten to fnteen minims of 
hydrobromic acid to each dose. Salicylic acid ten to twenty 
grains, or the salicylate of soda in the same dose, is a valuable anti- 
pyretic. It requires to be watched. 

Warburg's tincture, the basis of which is quinine, has a power- 
ful antipyretic effect 

Cold may be applied in suitable cases. The ice-cap is best ; it 
comforts, relieves the throbbing headache, and the temperature 
usually falls. When the temperature reaches 105 , cold to the 
body may be used, but only as a temporary expedient. 

Where there is much tympanites, turpentine, fifteen to twenty 
minims, may be given in mucilage. It acts as a 
stimulant. 



2SO COMPLICATIONS OF PARTURITION. 

Purgatives are doubtful and often exhausting. 

ALFRED MEADOWS, M. D., LONDON. 

Quiet the system by opiates in the early stages, moderately 
excite the bowels by a saline, stimulate the skin by small doses of 
carbonate of ammonia or other stimulating diaphoretics. Local 
applications, poultices to the abdomen to keep the part warm and 
moist, will be of service, and opium may be added to these. 

When the reactive phenomena of inflammation are well marked, 
leeches may be applied over the abdomen, from six to twelve, as 
may be demanded. 

Venesection, when needed, must be pleno rivo, thus producing 
the effect at once, and with less loss. Next, nauseating doses of 
tartar emetic to lower the force of the heart's action; and if the 
pulse again becomes hard and full, repeat the bleeding till the 
disease is subdued. Calomel and opium freely, in order that the 
system may be brought quickly under the mercurial. Mercurial 
frictions may be used. Turpentine has been successfully given in 
y 2 ounce doses, two or three times a day, especially in tympanites. 

The uterus should be well disinfected by warm water and 
carbolic acid, or Condy's fluid. If there be much pain, give 
Dover's powder frequently, and keep up the strength. 

His own plan is to support by a moderate use of stimulants, a 
hot, dry skin being a contra-indication; warm emollients to the 
vagina and to the abdomen ; cleanliness in the atmosphere, the 
clothes and the uterus. The diffusible stimulants, opiates, salines, 
diaphoretics, and vegetable tonics, when the acute symptoms are 
gone, are the drugs to be preferred. With a high temperature, 
pulse quick, hard and full, skin hot and dry, nothing can compare 
with aconite, one drop every hour. 

THE ANTISEPTIC MANAGEMENT OF LABOR 
Has been recommended by a committee of the Berlin Obstetrical 
Society, as a preventive of septicemia. 

BISCHOFF AND ZWEIFEL 

Prescribe cleanliness in the parturient woman and her surround- 
ings ; the use of antiseptic injections in the vagina in the beginning 
and at intervals during the course of labor; and the thorough 
disinfection of the hands before, and inunctions with carbolized oil 
during examinations, Immediately after delivery, the vagina i*s 



PUERPERAL FEVER. 28 I 

injected, as well as the uterus, if its cavity has been entered by the 
hand ; and, during the puerperal state, vaginal injections are con- 
tinued daily. The vulva and perineum are protected by a pad 
soaked in ten per cent oil, which is frequently renewed. 

PROF. ZWEiFEL, ERLANGEN. 

Antiseptic Midwifery* In the Berliner Klin. Wochensckrift, No. I, 
1878, he alludes to the plans of several authorities: Bischoff, of 
Basle, gave a bath at the outset of labor, washing out the vagina 
with a two per cent, carbolized lotion, anointing the fingers of the 
attendant with a ten per cent, lotion at every examination, previ- 
ously disinfecting the hands by washing in carbolized water. 
When the hand must be passed within the uterus, or if the foetus 
was well decomposed, the cavity was irrigated well with the lotion, 
and the injections were continued for thirteen days after delivery. 
After labor, any wound was touched with a ten per cent, lotion. 
A pad of wadding soaked in carbolized oil, one part to ten, was 
placed at the opening of the vagina, and frequently renewed. 

H. Fehling, at Leipsic, applied salicylic acid and starch, one 
part to five, to all wounds, and syringed the vagina several times 
a day, in case of fetid discharge, with a salicylic lotion. 

Schuckixg employed at the close of labor a carbolized lotion of 
five per cent., to irrigate the parts. 

Zweifel's own method is partly the use of antiseptic measures, 
and partly adoption of the most scrupulous cleanliness in connec- 
tion with the surroundings of the puerperal woman. All vaginal 
examinations dining pregnancy are made only after careful wash- 
ing of the hands and smearing with carbolic oil, the vagina being 
further washed out afterwards in some cases with five per cent, 
carbolic solution. The reason for these precautions is the possi- 
bility of infectious matter being introduced into the vagina previ- 
ous to labor, of its lying there and being sucked up into the uterus 
after the expulsion of the foetus. 

The rooms and beds destined for the use of the lying-in, are 
carefully disinfected by burning sulphur in them in fire-proot 
vessels, allowing about four grammes of sulphur to each cubic 
metre of space. The bedclothes are spread out so as to expose as 
large a surface as possible to the fumes, which, after a few hours, 
are allowed to escape by opening the windows. 

After each labor in which the hand has been introduced into 



282 COMPLICATIONS OF PARTURITION. 

the uterus, or where air has gained entrance to it, or gaseous 
decomposition occurred in it, the uterus is washed out with several 
litres of fresh water. 

Since almost all the cases of puerperal fever are found to be 
complicated either with ruptured perineum, small rents in the 
vagina and vulva, or with the introduction of air into the uterus 
during some operation, the greatest care is bestowed on all ex- 
ternal wounds, to which Fehling's mixture of salicylic acid and 
starch is applied with the best results. Careful examination of the 
external genitals day by day, and the use of the thermometer, are 
also rigorously attended to. 

PUERPERAL FEVER. 
DR. FRITSCH, OF HALLE, 

In the Sammlung Klinischer Vortrager, No. 107, insists on pro- 
phylaxis. A bottle of strong carbolic acid solution is always to be 
carried. Before examination, the hands, washed, are to be disin- 
fected with the acid and a nail brush. When labor sets in, the 
woman is to be placed in a hip-bath, well washed with soap, and 
the vagina syringed and the vulva cleansed with carbolic acid. 
Repeat if labor is slow, and before and after any operation. Fehl- 
ing, of Leipzig, has abandoned parturition under carbolic spray, 
believing that it predisposes to post-partum hemorrhage. The 
author recommends its use in lying-in-hospitals at all operations 
when fever is endemic. After delivery in all cases the vagina is to 
be syringed and the vulva cleansed with the acid twice a day. If 
fever arise, and where a foetus is decomposed, intra- uterine injec- 
tions are used. 

SEPTICEMIA. 

S. E. ROBINSON, M. D., WEST UNION, IOWA, 

Gives (in Med. and Surg. Reporter, 1878) his success in the pro- 
phylaxis. He learned the plan from Prof. Cleaver, of Keokuk, 
who directed a copious vaginal injection of carbolized water three 
or four times a day for several days after delivery. Dr. Robinson 
has followed this plan for several years, and has failed to see any 
case of puerperal infection since. 

WALTER IZARD, M. D., LIBERTY, VA., 

In the Va. Med. Monthly, Aug., 1878, regards the cause to be 
the retention and absorption of excrementitious and morbific mat- 



PUERPERAL FEVER. 283 

ter. Hence he strikes at the root by employing, not intra-vaginal 
washes, but intra-uterine. He employs a double catheter similar 
to that in common use for washing out the bladder, only with a 
larger and more gradual curve, and a slight prolongation of two 
tubular orifices through which the injected fluid makes its en- 
trance and exit; the exit tube should be several sizes larger than 
the other. It may be made of gutta percha or silver ; two pieces 
of rubber tubing 2 1 /? to 3 feet long should then be fitted to the 
tubular orifices ; to that of entrance a large glass funnel should be 
attached. 

Everything being prepared, and the patient occupying the dorsal 
decubitus, with the lower extremities flexed, and the body having 
been placed near the edge of the bed by assistants, the left index 
finger, well oiled, should be placed in contact with the external os 
uteri ; then the catheter, passed along this finger as a guide, should 
be passed to the fundus uteri — meeting in this condition no resis- 
tance at the internal os. Then the fluid having been poured into 
the funnel, it should be raised to the height of two feet above the 
bed, and the fluid allowed to flow ♦into the uterus, the only force 
used being hydrostatic pressure. The fluid will be found to return 
almost immediately through the waste tube, so changed in appear- 
ance as to leave no doubt as to whether it has come in contact 
with the internal uterine walls or not. This funnel arragement is 
the one calculated to accomplish the desired end with the least pos- 
sible amount of injurious force. By the Davidson's or any other 
pump-syringe, the fluid is thrown in with such force as almost to 
render its escape through the Fallopian tubes a certainty. 

The washing out of the uterine cavity should cause no pain, 
although slight uneasiness is sometimes complained of by patients 
during the introduction of the instrument. The fluids used for 
washing out the uterine cavity have been several — preferably potas- 
sae permanganate (grs. 7J to one pint of tepid water), or carbolic 
acid (5j. to the pint of water) and a weak solution of salicylate ot 
soda in glycerin and water. 

JOSEPH HOLT, M. D., OF NEW ORLEANS. 

In reviewing the subject, this writer says (New Orleans Medical 
Journal, Sept. 1876), that the physician's first duty is, to guard 
every obstetric patient against septic contamination from without, 
by refraining from attending such cases if we have reason to be- 



284 COMPLICATIONS OF PARTURITION. 

lieve that our hands or clothing are infected ; by the liberal use of 
disinfectants about the apartment or premises, and even removing 
the patient if we suspect the unhealthiness of the locality. 

We are to guard against auto-infection by cleanliness, by the 
free use of vaginal injections when there is even the slightest pu- 
tridity of the lochia, by the immediate removal of any remnant of 
decomposing placenta or coagula, by the avoidance of anything 
likely to check the lochial discharge, as cold and dampness, and 
when it is checked, inviting it again by the repeated warm douche. 
As a disinfecting wash, he earnestly recommends the formula of 
Dr. I. L. Crawcour, of New Orleans : 

269. T$. Acidi carbolici, §j 

Tincturae iodinii compositae, f.^ss 

Glycerinae, fjijss, M. 

Sig. — A tablespoonful to be stirred into a quart of tepid water, and in- 
jected high up in the vagina two or three times daily, as the case 
may require. 

If infection has already occurred, we are to look to antiseptic 
remedies as offering the most reasonable hope of success. If pu- 
erperal fever is septicemia, it is irrational to expect a positive con- 
trolling influence from opium or calomel, purgatives, emetics, ven- 
esection, cardiac sedatives, or any other remedy not having the 
quality of directly disinfecting the blood. 

There is no doubt but that some of these drugs and expedients 
are extremely useful in the treatment of this disease, but as a main- 
stay, experience has taught that none of them are to be relied 
upon. He has administered, with an apparent speedy amelioration 
of symptoms, the following formula : 

270. 



Sig,- 



^. Acidi carbolici, 


gtt.xx 


Sodii sulpho-carbolatis, 


?ss 


Glycerinae, 


f.!j 


Aquae, 


f.!v. 


-Tablespoonful every three hours. 





M. 



The old remedies, approved by experience, are called for when 
specially indicated ; as in many cases keeping the bowels freely 
open by mercurial purgatives, the pill of calomel and compound 
extract of colycynth, subduing excessive heart action with vera- 
trum viride, blistering when the inflammation localizes itself, and 
attending to the state of the lochial discharge. 

In cases where the local inflammation is attended with excruci- 



PUERPERAL FEVER. 2S5 

ating pain (of such common occurrence), he has been able to con- 
trol it perfectly by applying over the suffering part a fly-blister, 
removing the cuticle, and then laying on a plaster composed as 
follows : 

271. 1$. Ex. belladonnas, 

Ex. opii, aa 5j 

Adipis, l). M. 

For a plaster. 

The effect of this plaster is so tranquilizing as to do away with 
the necessity of narcotics given internally. The physician must 
carefully watch its effect, and remove it for a while if much nar- 
cotism is induced, protecting the blistered surface in the meantime 
with an emollient poultice. The strength of it may be increased 
or diminished according to the effect, and it may be continued as 
long as there is abdominal tenderness. 

PROF. CARL RICHTER, M. D., OF BERLIN. 

The treatment of puerperal disease pursued by this writer 
(ZeiischiHft fur Gyn., 1877,) may be briefly stated as follows: As 
soon as the lochia became offensive or arrested, or offensive 
placental debris or coagula were discharged, or the temperature or 
pulse rose, or any inflammatory reaction in the genital tract ap- 
peared, or the uterine regions and surroundings became sensi- 
tive, or the broad ligaments appeared swollen — at once the uterine 
cavity and vagina were thoroughly washed out, first with a three 
per cent., then with a two per cent, carbolic solution, two or three 
times a day; the permanent ice-bladder was applied, preceded, if 
indicated, by leeches ; and, according to the severity of the symp- 
toms, first salicylate of soda in doses of gr.xv-xxx several times a 
day. The ice was continued so long as sensitiveness remained ; 
the irrigations and soda salicylate, until pulse and temperature 
were reduced to the normal. 

It should be mentioned that a combination of sulphate of quinia 
(gr.viij), with soda salicylate (gr.xv-xxx), could be relied upon 
with tolerable certainty, although but temporarily, to reduce the 
high temperature, without causing salicylic intoxication ; a ten per 
cent, solution of carbolic acid was very useful as a local applica- 
tion to wounds of the parts. 



286 COMPLICATIONS OF PARTURITION. 

PUERPERAL SEPTICEMIA. 
W. H. PARISH, M. D., PHILADELPHIA, 

In a paper read before the Philadelphia Co. Med. Soc., being a 
clinical study of the cases at the Philadelphia Hospital, concludes 
as follows : 

Puerperal fever and puerperal septicemia, are dependent upon 
one and the same poison, and this poison originates in a great va- 
riety of forms of decomposing organic material. The source of 
the poison may be within the woman herself, or it may have its 
origin in sources external to her. 

Puerperal fever or puerperal septicemia may be conveyed from 
one puerperal patient to another. 

If a lying-in patient is suffering with traumatic inflammation, she 
is thereby rendered more liable to internal infection. 

The poison develops with great rapidity in a lying-in patient, 
suffering with traumatic inflammation, and from her it may be 
transferred to other lying-in patients, and in them it may produce 
septicemia or puerperal fever, though the original patient may 
herself have escaped infection. 

In a patient suffering with auto-genetic infection, the symptoms 
vary greatly, according to the absence or presence and degree of 
traumatism, and according to the special mode of the internal in- 
fection. 

The symptoms in patients suffering from external infection are 
more uniform in their manifestations, as are also the pelvic and 
abdominal lesions. 

The treatment of cases of internal infection must vary greatly 
for the same reasons that the symptoms vary. 

In cases of external infection, the treatment is more uniform, 
and should consist, as a rule, of local abstraction of blood by 
leeches, 16 to 20 f.o, of warm, moist applications, of warm, dis- 
infecting vaginal or intra-uterine injections, of quinia in full doses, 
of morphia as a calmative, of a mild diuretic, of stimulants accord- 
ing to depression, of moderate constipation after an enema, and of 
liquid and highly nutritious diet. 

The prophylaxis is of, however, paramount importance, and 
should consist of measures that will prevent the formation of 
septic material within the woman, and that will prevent the con- 
veyance of septic material to her person from external sources. 






PUERPERAL FEVER. 2%J 

RESUME OF REMEDIES. 

Acetum. As a germ destroyer and disinfectant, Dr. Alexander Simpson, 
of Edinburgh, calls attention to common vinegar, which on 
many occasions lie has found extremely efficacious {Trans. In- 
termit. Med. Congress, 1876). 

Aconitum. Phillips is very positive as to the good effects of aco?iite in 
drop doses every hour or two day and night. If employed im- 
mediately after signs occur, it will be most beneficial. 

Alcohol in strong solution has been used by French practitioners. 

Arnica is used by Dr. Miller. 

Calcii Chloridum in weak solution is available. 

Carboliciim Acidum is the most widely used of the antiseptic agents. 

Chloral Hydras. Dr. J. A. Larrabee, of Louisville, has found a solution 
of chloral of mild strength, gr.x to f.lj, much more efficacious 
in checking an epidemic of puerperal fever than carbolic acid 
or anything else* {Half Yearly Compendium, July, 1878). He 
states that in all labors there is an odor to the lochia, plainly 
discernible at the end of the first twenty-four hours. If this 
condition remains uncorrected, and the nurse neglects to attend 
to her duties, there is great danger of septic poisoning. A so- 
lution of chloral of mild strength, in water, and by means of the 
douche or fountain syringe, removes at once not only the odor, 
but destroys the noxious influence of such poison. Carbolic 
acid, although it has been much lauded, is, in his judgment, 
entirely unreliable, and merely substitutes its own odor for 
that of the disease. 

Ferri Subsulphas is an antiseptic agent of value, as well as a hemostatic. 
Dr. H. P. C. Wilson, of Baltimore, recommends that it be com- 
bined with glycerine when used in the uterine cavity. 

Iodinium. Dr. E. J. Tilt believes that tincture of iodine is the best dis- 
infectant for uterine injections. He uses as an injection after 
labor, four drachms of the tincture in half a pint of tepid water. 
He speaks very highly of the results of the practice of Dr. 
Dupierris, of Cuba, who had great success in preventing and 
curing puerperal fever by injecting into the womb, immediately 
after removing the placenta, the following : 

272, ]£. Tincturae iodinii, f.5iv 

Potassii iodidi, gr.x 

Aquae destillatae, f,§j. M. 

For one intra-uterine injection. 

Opium and Morphia. Enormous doses of these preparations can be taken 
with advantage in puerperal fever. Dr J. P. White, of Buffalo, 
says he has given as much as one grain of morphia every hour 
for forty-eight consecutive hours, with success. Dr. E. H. 
Trenholme, of Montreal, gives from one grain to a grain and 
a third hourly, and has never lost a case. {Trans. Internal. 
Med. Congress, 1876.) 



2 88 COMPLICATIONS OF PARTURITION. 

Fotassii Permanganas in weak solution answers very well as an antiseptic 
wash. One objection to it is, that it stains the bedding, etc. 
Where soreness and tenderness of the vagina after labor are 
complained of, Dr. P. J. Murphy, of the Columbus Hospital 
for Women, Washington, uses : 

273. I£. Potassii permanganatis, 3j 

Potassii chloratis, 5iv 

Aquae, Oij. M. 

A teacupful to be added to a quart of warm water, and used as 
a vaginal injection night and morning. Dr. Bartholow 
states that internally it has been given with advantage, gr. 
}(-), in water, three times a day. 

QuinicB Sulphas, especially in the form of "Warburg's tincture" has 
lately been asserted to be a very valuable remedy in puerperal 
septicemia. Cases are given by Dr. A. Baird, Edinburgh, 
Med. Jour., hug., 1879. Bartholow speaks of the undoubted 
good effects of quinia in doses of gr.v-xx, every four hours. 

Salicylicum Acidum has been used both locally and internally. 

Sodii Benzoas has been introduced comparatively recently by Prof. 
Klebs, of Prague. It is said to be useful in every kind of 
septic injection. The dose is 5ij-iv in solution, repeated as 
needed. A few cases have been reported in which its adminis- 
tration seemed to do good, but they have not been sufficiently 
numerous to be decisive as to its merits. 

Sodii Salicylas, as more agreeable than the acid, should be preferred for 
internal use. 

SulpJuirosum Acidum, for injection and irrigation, has been advocated. 

Terebinthince Oleum is said, by Bartholow, to have decided clinical 
experience in its favor. 

Thymol has been employed as an antiseptic by Dr. Miller. 

Veratrum Viride has its defenders as a valuable means to control arterial 
action. But the present tendency is to distrust this drug. 

GENERAL MEASURES. 

Blisters are often of great service. 

Purgatives have been long used in the treatment of this condition. 

Venesection is less used than formerly. As the disease is one of an asthenic 

character, the cases in which loss of blood is desirable must be 

very rare and exceptional in number. 



PUERPERAL THROMBOSIS AND EMBOLISM. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

When there are evidences of pulmonary obstructions generally, 
the fatal results follow so speedily that no time is given to do any- 
thing. Keep the patient alive by stimulants, brandy, ether, ammo- 
nia. Possibly leeches or dry cups to the chest might aid in reliev- 
ing the circulation. Enjoin the most absolute and complete repose, 
with the hope that the vital functions may be continued until the 
coagulum is absorbed or lessened, so as to permit the passage of 
the blood. Death often follows the most trivial exertion, such as 
rising out of bed. Feed the patient with abundant fluid food, 
milk, strong soups, and the like. 

Richardson suggested ammonia. He has since advised liquor 
ammonia in large doses, 20 minims every hour, in the hope of caus- 
ing solution of the deposited fibrine, and says he has seen good 
results of it. Others urge the use of alkalies to favor absorption. 
The best that can be said of them, is that they are likely to do 
much harm. 

Where there is evidence of obstruction in a limb or other point, 
nothing can be done. Rest absolute, generous diet, and sedatives 
for pain, is all. In case of gangrene of an extremity, amputation 
above the line of demarcation may save the life of the patient. 

THROMBUS. 

PROF. F. WINCKEL, M. D., ROSTOCK. 

If the vagina be the location, plug with cotton wool or with a 
colpeurynter filled with ice-water. Cold to the tumor if in the 
labia, and ice, digitalis and opium internally, the latter to allay ex- 
citement and pain. W 7 hen it ceases to enlarge, use absorbents. 
Do not open unless a special indication to that effect exists. Em- 
ploy ice compresses, cloths soaked in warm lead water and opium, 
4 drachms tinctura opii to one pound of lead water, infusion of 
chamomile flowers, arnica, etc. 

If the tumor does not decrease, the pain is intense, and the skin 

gets darker, open, turn out the clots, and if the bleeding continues, 

fill the cavity with charpie soaked in solution of tannin, or, better, 

a 3 per cent, solution of carbolate of soda; lay a compress over it, 

19 (289) 



29O COMPLICATIONS OF PARTURITION. 

and secure with a T bandage. It is best to wait if possible until 
the hemorrhage has ceased before opening the tumor. General 
indications will be to support the system, and give quinine and 
acids. 

Vaginal thrombus usually arises immediately during or after 
child-birth, and is formed in the loose tissue between the vagina 
and rectum, whence, however, it sometimes extends to the gluteal 
regions, and even to the thighs and psoas muscles. The treatment 
as recommended by Dr. Kucker ( Wiener Medical Wochenschrift, 
No. 52, 1878), consists in the prompt application of cold, as ice 
and ice water, and compression. As soon as the thrombus ceases 
to extend, poultices are indicated. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

If the thrombal tumor be not so large as to cause great pain by 
its pressure on the adjacent tissues, or to interfere materially with 
the delivery, or if laceration and escape of blood almost immedi- 
ately follow the development of the tumor, apply the forceps and 
deliver at once. Arrest the flow of blood which usually occurs at 
the moment of the delivery of the head, with compresses of cotton 
batting saturated with a solution of the subsulphate of iron. As 
soon as this hemorrhage is controlled, deliver the placenta. He 
opposes the use of the tampon on the ground that it retains the 
lochial discharge, and exposes the patient to septic poisoning. 

To the laceration he applies a lotion of carbolic acid and glycer- 
ine, not only as an antiseptic, but as a means of protecting the 
parts from excoriation by the irritating discharges of the urine 
and the lochia. Avoid disturbing the coagulum formed by the 
subsulphate of iron, so as to avoid secondary hemorrhage. As a 
precaution against this accident, the bladder should be evacuated 
for several days by a catheter. 

When the tumor has attained such a size as to offer a mechanical 
obstacle to delivery, incise at once, remove all clots that have 
been formed, and then deliver by the forceps. The longer the 
incision is postponed, the greater will be the amount of extravasa- 
tion, the greater the distension of the parts, and the more extensive 
the laceration of the areolar tissue. 

If the laceration does not appear until after delivery, incision 
should not be made so long as the tumor is increasing in size. 
He advises that the physician should wait until after the coagulum 
is formed, which arrests the hemorrhage by pressure on the lacer- 
ated vessels. 



PUERPERAL SHOCK. 

PROF. WM. LEISHMAN, M. D., GLASGOW. 

Shock to the nervous system by a tedious or severe labor may 
prove fatal, without hemorrhage or organic injury. As Travers 
observes, pain of itself is destructive. This author believes it must 
be the pain of the second stage. The treatment is the union of an 
anodyne with stimulants; wine and brandy freely, till reaction is 
obtained, and then substituted by chicken broth. Meantime, give 

274. I£. Mist, camphorae, f.^vj 

Ammon. carb., 5ij 

Tr. oph, s gtt.lx. M. 

Dose. — Tablespoonful every one, two, or three hours. With this, she 
must be perfectly quiet, the room darkened, and the patient allowed 
to sleep as long as she can. 

It "is with the view to avoid the shock, the exhaustion of the 
second stage of labor, that the editor would urge the use of chloral, 
until the delivery can be accomplished by the employment of the 
forceps. The best treatment will be to prevent shock by avoiding 
its causes. 

It would appear that chloral, even while producing a calm, re- 
freshing sleep, does not by any means check the progress of labor 
when this has commenced. For it is invariably found that dilata- 
tion has continued, and generally so readily is this accomplished, 
that a speedy delivery often follows its use. The editor regards 
this remedy as producing results similar to those of ensesthetics 
in surgery, and therefore similarly indicated. Again, while it re- 
lieves the pains of travail, it thus greatly contributes to a safe and 
speedy convalescence. It prevents the terrible exhaustion and 
shock to the system too often seen to follow an unaided labor.* 

* On the prevention of shock by the early use of the forceps, see also that 
subject in " Hints in the Obstetric Procedure." 

(291) 



PELVIC CELLULITIS AND PERITONITIS (PUERPERAL 
PHLEBITIS AND METRITIS). 

T. G. THOMAS, M. D., NEW YORK, 

Has tabulated the points of differential diagnosis between pelvic 
cellulitis and peritonitis as follows : 

Peritonitis. 

Board-like feel to the vaginal roof. 
Tumor very high, only felt in the 
vaginal cul de sac ; does not ex- 
tend above the superior strait. 

Suppuration rare. 

Abdominal tenderness excessive 
above the brim. 

Tumefaction near or upon the me- 
dian line. 

Tendency to monthly relapse very 
marked. 

Pain excessive, often paroxysmal. 

Very anxious. 

Nausea and vomiting often exces- 
sive. 

Always accompanied by tympanites. 

Uterus immovable on all sides. 

Always displaced. 

Diseases of the ovaries, gonorrhea, 
exposure during menstruation, 
fluid in the peritoneum. 





Cellulitis. 


I. 


Tumor easily reached ; general- 




ly felt in one broad ligament; 




may be felt above the pelvic 




brim. 


2. 


Marked tendency to suppura- 




tion. 


5' 


Abdominal tenderness in one 




iliac fossa. 


4 


Tumefaction laterally in the 




pelvis. 


5- 


Tendency to monthly relapse 




not marked. 


6. 


Pain severe and steady. 


7- 


Facies not much altered. 


8. 


Nausea and vomiting not exces- 




sive. 


9- 


Not accompanied by tympani- 




tes. 


IO. 


Uterus fixed to a limited extent. 


n. 


Not necessarily displaced. 


12. 


Cause. Parturition, abortions, 




operations on the pelvic viscera. 



PROF. WM. GOODELL, M. D. PHILADELPHIA. 

In Philadelphia Medical Pimes, Feb. 2., gives the following advice 
as to treatment : 

The disease having been recognized, administer at once a full 
hypodermic dose of morphia, and from ten to twenty grains of 
qitinia by the mouth. These measures, taken promptly, will often 
stop the disease at once. 

Failing to abort the attack, we must paint the abdomen with 

(292) 



PELVIC CELLULITIS AND PERITONITIS. 293 

iodine and put on a poultice, covering it with oiled silk, or greased 
brown paper; it will then remain soft for twenty-four hours. The 
patient must have large doses of q.uinia. If the temperature be 
high she should have ten grains at a time, and from thirty to forty 
grains in the course of the day. Large doses of morphia must also 
be given. If the woman be plethoric, the morphia may be given by 
the mouth, with neutral mixture and wine of ipecacuanha, or in 
some other fever mixture. In some cases tonics are demanded. If 
the sickness last for more than a week, and the local tenderness 
increase, put on a blister promptly. 

Later, muriate of ammonia is an excellent remedy in this disease ; 
so, too, is aconite. Dr. Goodell usually prescribes the following : 

275. I£. Mist, glycyrrhizae comp., f.§vj 

Ammonias muriatis, 5U 

Hydrarg. chloridi corrosivi, gr.j 

Tinct. aconiti radicis, gtt.xxiv. M. 

A tablespoonful in water every six hours. 

As concerns routine treatment, the patient should take plenty 
of milk, whisky, beef tea, and large doses daily of dialyzed iron. 

PROF. W. S. PLAYFAIR, M. D., LONDON. 

The important points are relief of pain, and absolute rest. If 
seen at an early stage, blood taken locally by leeches to the groin 
or to the hemorrhoidal veins may give relief. Leeches to the 
uterus are likely to cause harm by the irritation of passing the 
speculum. Opiates in large doses, or by suppositories, or subcu- 
taneously, are the best when the pain is at all severe. When par- 
oxysmal, use suppositories immediately the pain threatens. When 
there is much pyrexia, give large doses of quinine. Keep the 
bowels free ; nothing answers so well as castor oil, j£ a teaspoonful 
every morning. Warmth and moisture to the abdomen give great 
relief in the form of linseed meal poultices, or if these are too 
heavy, use spongeo-piline soaked in boiling water. Poultices may 
be sprinkled with laudanum or belladonna liniment. Absolute rest 
in the recumbent position must be enforced for some time after the 
symptoms abate. Then absorption may be favored by the long- 
continued use daily of tincture of iodine until the skin peels, or 
by frequently repeated blisters. This is better than keeping an 
open sore by irritants. When an abscess has formed and points 
in the groin, make a free incision, and employ antiseptics. Wait 






294 COMPLICATIONS OF PARTURITION. 

till the pus is near the surface. In these operations, the aspirator 
is a valuable instrument. 

Diet should be abundant, simple and nutritious. Make up for 
the drain caused by suppuration. Tonics, iron, quinine, and cod- 
liver oil, will be useful. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

In this disease this author directs absolute quiet in bed, and re- 
gards the danger of relapse as imminent if the patient gets up or 
moves much. If there be much pain in micturition, and the blad- 
der be not thus entirely emptied, a catheter should be used. He 
believes that the bowels should be kept free from fecal evacuations 
by teaspoonful to tablespoonful doses of the compound magnesia 
powder, or the compound licorice powder, of the German pharma- 
copoeia. If the pain be very acute in the commencement of the 
attack he usually overwhelms it by one hypodermic injection of 
morphia, and relies afterwards upon opium suppositories. The 
lower portion of the abdomen should be kept covered by hot poul- 
tices of ground flaxseed, over which should be placed oiled silk, so 
that the poultice may retain its warmth for some hours. After the 
acute stage has passed away, cotton wool wet with laudanum and 
also covered with oiled silk may be substituted for the poultices. 
For some years he has discarded cups, leeches, and local depletion. 

In the cases which assume a subacute or chronic form, he has 
witnessed much benefit from injections of water into the vagina as 
hot as can be comfortably tolerated. In the employment of these 
injections, the patient should lie across the bed, with the hips well 
over its edge and the feet upon two chairs. An India-rubber sheet 
should be placed well under her, between her hips and her cloth- 
ing, not only to prevent the latter from getting wet, but also to 
conduct the water, as it flows back from the vagina, down to a ves- 
sel which is placed on the floor. Then by the use of a Davidson 
syringe, two or three gallons of hot water may be injected into 
the vagina by the nurse. A still more easy method is to have a 
pail with a stop-cock at the bottom, which connects with a long 
India-rubber tube, having a vaginal pipe at the end. This pail, is 
placed on an elevation of a few inches above the patient, and the 
water is allowed to run in and out of the vagina. Not only do 
the patients generally derive great comfort from this warm poul- 
ticing, but if the physician immediately after makes a vaginal ex- 



PELVIC CELLULITIS AND PERITONITIS. 295 

animation, he will need no argument to convince him what a 
powerful agent this is in modifying tjssue. 

He employs quinine at an early period of this disease, giving 
it in as full doses as the patient can bear without inconvenience. 
If symptoms of suppuration, cachexia and hectic fever, come on, 
he relies on quinine and alcohol pushed to the point of tolerance, 
as internal remedies, and on surgical means for giving exit to the 
purulent collection. 

So soon as the least fluctuation can be detected in any part of 
the pelvic cavity, Prof. B. directs that it be aspirated. He con- 
siders this a safe procedure — that it gives immediate relief to 
pain, that it shortens the duration of the disease, and is a prophy- 
lactic measure against disorganization of adjacent tissues. 

Puerperal metritis. Ifshe finds the patient with pain in the hypo- 
gastrium, and the uterus larger than it should be at the time of the 
puerperal period and painful on pressure, the lochia diminished in 
a marked degree, or perhaps wholly arrested ; or, on the other 
hand, a return or positive increase in the amount of blood lost in 
the discharge, with a quick pulse, and more or less fever, he at 
once gives the following powder well mixed in a wineglass of 
sugar and water : 

276. ^. Tully's powder, 

Potass, bicarb., aa gr.x 

Hydrarg. chlorid. mite, gr.v. M. 

If the skin be very hot and dry, and the pulse very hard, he 
may substitute the following : 

277. I£. Pulv. potass, nitrat., gr.x 

Pulv. gum camphor, 

Hydrarg. chloridi rhitis, aa gr.v 

Pulv. Jacobi veri, gr.iij 

Pulv. opii, gr.j 

Vel. morphise sulp., g r -X- M. 

He anticipates the following effect from these powders : The 
pain will be relieved; nervous irritation allayed; sleep induced; 
fever subdued ; diaphoresis promoted ; and eight or ten hours 
after, an easy revulsive cathartic action will follow. If cathartic 
action do not follow in ten hours, he orders a saline cathartic. 

He also directs that turpentine stupes be applied over the uterus 
and kept on until the patient insists on their removal, when cotton 
batting should be laid over the uterus, and this should be covered 



296 COMPLICATIONS OF PARTURITION. 

with oiled silk. If the patient complains of severe pain or burning 
from the turpentine, the cotton may be wet with laudanum. If the 
disease be of a sthenic type, he has derived great benefit from the 
application of six or eight wet cups over the uterus, but repudiates 
the use of leeches as very objectionable. If after two or three days 
there be not evident decrease in the uterine tumor, applies a blister 
over the uterus. In cases in which the uterus does not undergo 
the usual involution, while the lochial discharge is profuse and 
sanguineous, he has derived advantage from the following combi- 
nation : 

278. ^. Ext. ergot, fid., 

Tinct. nucis vomicae, 

Tinct. ferri chloridi, aa f.fss 

Glycerine, 

Syrup aurant. cort, aa f.^j. M. 

Sig. — Teaspoonful in a wineglassful of sugar and water every fourth 
hour. This usually reduces the size of the uterus, and diminishes 
the hemorrhagic lochia within twenty-four hours. 

He also regards vaginal injections as absolutely essential 
throughout the whole treatment of puerperal metritis. Formerly 
he used Labarraque's solution of the chlorinated sodium in warm 
water, as strong as the patient can bear without smarting ; recently 
he has employed the following: 

279. fy. Acid carbolic, glacial, 

Glycerine, aa f.§j 

Aquas purae, fl§vij. M. 

Sig. — A tablespoonful in a tumbler of warm water. 

If the lochial discharge be very purulent, and particularly if the 
odor be offensive, the injections should be used four, five, or six 
times a day. If the discharges be positively fetid, this author 
advises intra-uterine injections; and that intra-uterine injections 
be given with either a Scanzoni or French irrigator, or a fountain 
syringe, because we can thus adjust the force with which the fluid 
enters the uterine cavity. He believes that the fatal results which 
have ensued in the employment of intra-uterine injections, have 
accrued from their improper application. The danger seems to 
arise from the entrance of air into a vein, as in some cases, in which 
death has been sudden, or from the passage of fluid into the Fallo- 
pian tubes, and peritonitis or phlebitis has ensued. 

In the suppurative and putrescent stages of puerperal metritis, 
our main reliance in connection with the intra-uterine injections 






PELVIC CELLL I ITIS AND PERITONITIS. 297 

must be on alcohol and quinine. He prefers giving the quinine in 
closes from five to ten grains twice a day, instead of the smaller 
doses frequently repeated. The whiskey or brandy should be 
administered as freely as the patient can take it without any 
unpleasant effects. 

Puerperal Peritonitis. For this disease this author regards opium 
as the great remedy ; that it retards or arrests the peristaltic move- 
ments of the bowels, gives the inflamed parts absolute rest, pain 
is relieved, nervous system tranquillized, sleep secured, and thus 
the depression of the vital forces, resulting from the shock of the 
attack, is lessened. The opiate, therefore, should be given in such 
doses as to secure all these. The amount is only limited by the 
effect produced. It should be given freely until some narcotism is 
produced, and the respirations diminished in number, but it should 
not be pushed beyond this point. If the respirations fall below 
twelve or fifteen, and the pupil be much contracted, the opiate 
should be withheld until these effects pass by. This line of treat- 
ment should be pursued until the inflammation is completely ex- 
tinguished. 

Our author directs that we begin treatment by giving ten drops 
of Magendie's solution every hour, and gradually increasing the 
dose if the effects sought be not manifested. If the drops be 
rejected by the stomach, administer morphia hypodermically until 
the stomach will tolerate it. In some cases the tolerance of opium 
is remarkable. One case took 106 grains of opium and its equiv- 
alent in morphia during the first twenty -six hours, and in the 
second twenty-four hours 472 grains of opium. 

Prof. B places also a high estimate on veratrum viride in al- 
laying vascular excitement. In conjunction with morphia, it re- 
duces the number of pulsations without reducing the strength or 
increasing the degree of vital depression. 

For the pain in the abdomen and the tympanites, he applies the 
oil of turpentine on two thicknesses of flannel, previously dipped 
in hot water and wrung out as dry as possible; this to be left on as 
long as the patient can be induced to bear it. On taking off the 
flannel the abdomen should be covered with a light layer of cotton 
wool, at least an inch or two in thickness and wet with laudanum. 
The turpentine stupes should be reapplied once or twice a day, if 
the abdomen show a tendency to again become distended and 
painful, and the cotton batting with the laudanum should be reap- 



298 COMPLICATIONS OF PARTURITION. 

plied every few hours. In cases in which the symptoms of perito- 
nitis have in a great measure subsided by apparent localiza- 
tion and induration, almost forming a circumscribed tumor, our 
author has witnessed much benefit follow the application of a 
blister. He directs that it be applied in the morning, so that it can 
be well watched, and that it be taken off and a warm poultice 
applied as soon as vesication has fairly commenced. In this way 
the blister is well filled with serous exudation, there is very little 
pain or soreness, and all danger of strangury is averted. 

In all cases in which the peritonitis is a complication of puer- 
peral fever, he has found quinine an efficient remedy, especially in 
cases in which the chills are recurrent, or when there are symp- 
toms indicating a tendency to purulent exudation. He prefers 
giving it in one or two impressive doses during the day to the 
small and frequently repeated doses — that is, give about five to 
ten grains in the morning and from ten to twenty in the evening. 
There is a decided tolerance to quinine in this disease. He also 
values alcohol in this disease. It renews the nervous forces, which 
are generally in a state of extreme prostration, probably by 
the cerebral hyperemia induced by the alcohol. In this, as in 
other diseases with great depression, patients are able to bear four, 
five, or even ten times the quantity that could be taken in health, 
without the least approach to intoxication. It diminishes waste, 
and thus tends to cause a diseased structure, in which vital changes 
are abnormally active, to return to its normal and much less active 
condition. With the whiskey or brandy he combines veratrum 
viride if there be considerable vascular excitement. This combina- 
tion often reduces the pulse when either of these agents individu- 
ally fail. 

He also recommends the following vaginal injection: 

280. I£. Glycerin, 

Acid, carbolic, glacial, aa f.^j 

Aquae purae, f.^vj. M. 

Sig. — A tablespoonful added to half a pint of warm water, and care- 
fully injected into the vagina twice a day. If the lochia be very 
abundant and fetid, the amount of carbolic acid may be doubled or 
even quadrupled. 

The food should consist of beef tea, panada, caudle, milk,* and 
lime water. 

Our author has no confidence in the aplastic properties of mer- 



PELVIC CELLULITIS AND PERITONITIS. 299 

cur) r ; yet in cases in which there is vomiting of bilious matter he 
gives ten grains of calomel well rubbed up with twenty grains of 
bicarbonate of sodium. 

Although generally averse to venesection in this disease, he 
believes it is strongly indicated in some of the more sthenic cases,. 
and employed with good results. 

Stimulants should be given so soon as feebleness of the pulse, 
clamminess of the surface, profuse perspirations, or cold extremi- 
ties, are noticed. Stimulants decrease the frequency and increase 
the force of the pulse. 

Another important point, is nutrition. Food in a liquid form 
should be taken as freely as it can be digested and assimilated. 
Milk, eggs, gruels, beef-tea, mutton broth, chicken soup, given 
every two or three hours, are useful. 

Purgatives, as a rule, are not desirable. Sometimes, however, 
when the tongue has a thick pasty coat, and there is a great deal of 
bilious vomiting, he gives a powder composed of from five to ten 
grains of calomel, and twenty grains of the bicarbonate of sodium. 

PROF. F. WINCKEL, M. D., ROSTOCK. 

Puerperal Metritis. He advises in this disease the horizontal 
posture; avoidance of all needless movements, and the use of 
enemata. When the abdominal pain is great, leeches may be 
applied to the abdominal wall ; but a speedier effect is obtained by 
ice water, compresses, and the ice-bag. When this can be dis- 
pensed with, inunction with fifteen grains of mercurial ointment 
should be made every two hours until salivation occurs, or with 
iodide of potassium ointment, together with warm compresses. If 
the discharge is offensive, inject with tar-water or permanganate of 
potassa, and with mucilaginous fluids. Promote absorption in 
every way, if there is effusion. If there is pus, evacuate speedily. 
When the fever subsides, give diuretics and iodide of potassium, 
five grains three times a day. 

PROF. WM. LEISHMAN, M. D., GLASGOW, 

The most important point is to relieve pain. When above the 
pelvic brim, poultices and fomentations with laudanum are most 
grateful. When vaginal, the douche, or medicated pessaries, may 
be used. Bernutz strongly urges the use of conium internally. 
The bowels are to be kept free, and the comfort of the patient is 



300 COMPLICATIONS OF PARTURITION. 

greatly aided by an injection of soap and water, to which turpen- 
tine may be added, given every night. Leeches to the locality 
may prevent suppuration. Bernutz insists that they should be 
applied directly to the uterus. Apply three at a time, and, if 
necessary, encourage the flow by a warm hip-bath. 

In addition to the remedies already mentioned by others, when 
not contra-indicated, use the pcrchloride of mercury, tV of a grain, 
until faint mercurialization occurs. ' Iodide of potassium, or the 
tincture of iodine, may be used with little hesitation.' Blisters may 
be used, but iodine is preferable, used externally, so as to continue 
its effects within moderate bounds for a long period. 

RESUME OF REMEDIES. 
Aconite is recommended by many (F. 275). Bartholow combines it 
with opium. 

281. R. Tinct. aconiti rad., f.Sij 

Tinct. opii deod., f-5yj. M. 

Dose. — Eight drops in water every hour or two. This in peritonitis. 

Acidum Carbolicum in vaginal injections. (F. 279, 280.) 

*Ammonii Murias is believed by many to act powerfully as a sorbefa- 
cient. 

Camphor a, in combination with nitrate of potassa and opium, is used 
by a number of practitioners. (F. 277.) 

Conium is. urged by Bermetz (p. 299). 

^Hydrargyrum, either by the mouth or by inunction, is generally em- 
ployed. 

*Iodinium. This remedy is highly useful, externally applied to the ab- 
domen. 

* Morphia. In full doses, and combined with quinia, is regarded by many 

practitioners as the best means of treatment. (See p. 292). 
Bartholow says that the hypodermic injection of morphia 

will sometimes jugulate peritonitis, if given at the outset. If 

the period for such a favorable result has passed, the course and 

duration can be greatly modified by opium judiciously used. 

The quantity will be determined by the effect ; the pain should 

be relieved, the pupils somewhat contracted. 
*Potassii Iodidwn, is very useful to aid in the absorption of effusions. 
Potassii Nitras is useful when the skin is hot and dry, and the pulse hard. 

(F. 277.) 

* Quinia must be given in large doses, and continued. 

Terebinthince Oleum, in the form of stupes, during the acute stage, is rec- 
ommended by Bartholow and others. 

Veratrum Viride, either alone or combined with morphia, to allay vascular 
excitement. 



PELVIC CELLULITIS AND PERITONITIS. 3OI 

OTHER MEASURES. 

Blisters favor absorption, and should be frequently repeated. 

Cold, in peritonitis, is recommended in the form of the ire bag by 
Winckel and Bartholow. The latter says when the inflam- 
mation is recent, the abdomen may be covered with an ice bag. 
It is proper to interpose a napkin between the skin and the 
bag. 

Injections of hot water are highly lauded, especially by Prof. Barker. 
They act like local poultices, and certainly are capable of great 
good. 

Vaginal injections of carbolic acid, permanganate of potassa, 
and chlorinated sodium, are also extremely valuable as disinfec- 
tants and antiseptics. 

Leeches applied to the groin or to the hemorrhoidal veins may be em- 
ployed. Never to the uterus. Barker discards them entirely. 

Poultices are very comforting by their warmth and moisture. These 
may be greatly aided by the addition of laudanum, belladonna, 
etc. 

Rest. This must be absolute, and not departed from until all danger of a 
relapse has disappeared. 



PHLEGMASIA DOLENS. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

The disease tends to a spontaneous recovery, and generally dis- 
appears without serious consequences. Hence any treatment 
which disturbs the system or the normal functions, is objectionable. 
The indications are : 

1. To allay the irritation of the nervous system, which can best 
be done by full doses of opium where there is no idiosyncrasy to 
prevent its use. 

2. To support the system by nutritious food, stimulants and 
tonics. Of the last mentioned, quinine and iron hold the first 
place. 

Only in cases where special indications exist should catharsis be 
induced, or cups be applied over the kidneys. In nearly all cases 
there is no occasion whatever for these. 

After the first two or three days, the disease becomes mostly 
local. The patient should keep quiet, the limbs be elevated at an 
angle above the trunk by raising the lower part of the mattress, 
and where there is hyperesthesia of the surface and pain in the 
deep-seated nerves, much relief will be obtained by gently rubbing 
the surface with a liniment like the following : 

282. I£. Linimenti saponis co., f.^vj 

Tincrurae opii, f.giss 

Tinct. aconiti radicis, f.§ss. 

Extracti belladonna?, ^ss. M. 

For a liniment. 

The rubbing with this should be gentle and continued for fif- 
teen or twenty minutes, and ahvays toward the trunk. This may 
be repeated every six hours, after which the leg should be envel- 
oped in cotton batting and covered with raw silk. 

After the period of acute tension, the leg should be examined 
for localized phlegmon, and if any circumscribed collection of pus 
be discovered, it should be evacuated at once ; otherwise the ton- 
icity of the tissues will best be promoted by applying a roller 
bandage, beginning at the toes and carrying it up the whole length 
of the limb. This should be worn so long as there is any ten- 
dency to oedema of the foot and leg. The patient should not be 

(3° 2 ) 



PHLEGMASIA DOLENS. 3O3 

permitted to walk until all evidence of local disease has disap- 
peared. 

PROF. W. S. PLAYFAIR, M. D., LONDON, 

Agrees in the main with the treatment above recommended. For 
the relief of the pain, he has found one of the best measures to be 
wrapping the entire limb in linseed meal poultices, or in warm flannel 
stupes, the surface of which maybe freely sprinkled with laudanum, 
chloroform, or belladonna liniment. Blisters, leeches, or any form 
of counter-irritation or abstraction of blood, he does not approve 
of. Internally he thinks chlorate of potassa, with dilute hydro- 
chloric acid, quinine, ammonia, and iron, are the drugs most likely 
to prove of service. As an anodyne, generally nothing answers 
so well as the hypodermic injection of morphia. 

At a later stage, support with a roller may be combined with 
gentle inunctions Of weak iodine ointment. And shampooing or 
rough friction of the limb should be avoided, on account of the 
danger of producing embolism. The occasional use of the elec- 
tric current is said to promote absorption. 

PROF. F. WINCKEL, M. D., ROSTOCK. 

The leg must be raised a little higher than the thigh, and the 
knee flexed ; the foot and calf supported by pillows to prevent 
the rotation outward ; apply compresses of lead- water ; rub over 
the skin about Poupart's ligament a piece of unguent, hydrarg. the 
size of a bean, three times a day. If the pain is acute add lauda- 
num to the lead-water. Open any vesicles that may form, and 
evacuate the serum. When the pain and swelling subsides, paint 
with tinct. iodine or Lugol's solution, and cover with wet com- 
presses ; bandage the leg to produce reduction. 

Bcer claims good results from a blister the width of two fingers 
around the thigh just above the knee. 

A proper support of the limb will be required when the patient 
leaves the bed. 



MILK FEVER. 

This affection, formerly so much dreaded, and believed so fre- 
quently to occur on the third day, on the occasion of the appear- 
ance of the milk, is now reasonably regarded as virtually a myth. 
In many instances, a slight increase of heat, pulse, etc., occurring 
at the time when the secretion of the milk commences, is regarded 
as a true form of fever, and treated with so much energy as fre- 
quently to induce a real disorder more or less serious. The best 
authorities now agree that the better regimen allowed to the 
lying-in woman, and the more sensible mode of conducting labor 
which at present has become the practice, prevents many of these 
abnormal tendencies. 

Playfair, Winckel, Grunewall, D'Espine, and others, agree 
in this belief, or regard the fever as a mild septicemia. Grailly 
Hewitt believes that it only occurs where the patient is weakened 
either by a prolonged and exhausting labor, from hemorrhage, or 
from insufficient nourishment. 



PROF. FORDYCE BARKER, M. D., NEW YORK, 

Regards it as an exceptional incident of child-bed, and gives the 
following prophylactic measures : 

Secure to the patient some hours of sound and refreshing sleep 
immediately after delivery. 

Give such food as will be abundantly nutritious, without over- 
taxing the digestive organs. 

Apply the child to the breast as soon as the patient has recov- 
ered from the exhaustion of labor. 

When the symptoms of milk fever present themselves, if the 
bowels have not been fully moved, give a saline laxative; subdue 
vascular excitement, and promote diaphoresis. The following is 
very effective : 

283. ^. 



Tinct. aconit. rad., 


gtt.xx 


Antimonii et potassa? tartratis, 
Spirit, etheris nitrici, 


gr-ij 


Syrupi simplicis, 
Aqiue aurantii flor., 


aa f.fj 

f.?ij. 



M. 
A teaspoonful in a wineglassful of sugar and water every two hours. 

Have the nurse gently but thoroughly rub the breasts from the 

(3°4) 






MILK FEVER. 305 

circumference toward the nipple with warm sweet oil every two 
hours till the distention has subsided, allay pain and nervous irri- 
tability, and secure sleep by a diaphoretic anodyne, as eight to ten 
grains of compound ipecac, powder or of Tully's powder. 

PROF. KARL SCHROEDER, ERLANGEN, AND PROF. W. LEISIIMAN, M. D. , 

GLASGOW, 

Agree that the milk fever is due to the distention of the breasts, 
and regardless of the amount of fever, these organs demand prompt 
attention, as by keeping them soft, frequently emptying them, ap- 
plying evaporating lotions, relieving the dragging, etc., by sus- 
pending the inflamed gland ; in short, by removing the cause, the 
fever itself is removed. 

20 s 



PUERPERAL CONVALESCENCE. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

During this period, the chief indications are : First, the restora- 
tion of the pelvic organs to their normal condition, and the devel- 
opment of lactation. The accomplishment of the first in the 
multiparas is usually attended with uterine contractions of an inter- 
mittent character. Our author thinks much can be accomplished 
by way of preventing their occurrence ; that they are usually the 
result of coagula in the cavity of the uterus which distend its 
walls, and excite spasmodic contractions. The retention of these 
may be obviated by firm pressure over the fundus during the time 
the trunk of the foetus is being expelled, and maintained until the 
placenta is delivered, and a permanent contraction of the uterus is 
secured. If the second stage is too rapid, or too prolonged, he 
gives a teaspoonful of the fluid extract of ergot, just as the delivery 
of the child is taking place. If the after-pains come on a few 
hours after the delivery, the first pressure should be renewed so as 
to expel coagula. It often gives relief. At a late period this must 
not be attempted, for fear that it may excite irritation and inflam- 
mation. He then relies on the following formula, known as Tully's 
Powder : 

284. B. Pulv. g. camphor, 
Cretae pp., 

Pulv. glychrrh., aa 3j 

Morphia? sulph., gr.j. M. 

Dose. — The same as Dover's powder. 

The severe after-pains sometimes occurring a day or two after 
labor, and excited by the pressure of flatus, must not be con- 
founded with peritonitis. This diagnosis is easily made ; while a 
slight touch causes pain, the pain entirely disappears upon contin- 
ued pressure; it returns as soon as the pressure is removed. On 
the other hand, the pain due to peritonitis will be increased in ratio 
to the pressure made. After-pains due to flatus are most speedily 
relieved by turpentine stupes and turpentine enemata. Sometimes 
after-pains of a purely neuralgic character are encountered. They 
do not yield to opium in its fullest doses, but are relieved by qui- 
nine and chloroform liniment. He gives the quinine in doses from 

(306) 



PUERPERAL CONVALESCENCE. 307 

five to ten grains, night and morning, and applies the liniment by 
saturating a piece of flannel of double thickness. The formula for 
the liniment is 

285. ^. Chloroformi, f.3jj 

Liniment, saponis co., f.3 v j. M. 

RETARDED INVOLUTION. 

If the uterus can be felt above the pubes a few days after partur- 
ition, our author prescribes the following : 

286. I£. Ext. ergot, fluid., 

Tinct. nucis vomicae, 
Tinct. ferri chloridi, 

Tinct. cinnamom cort., aa f.Jj. M. 

Sig. — Teaspoonful in <a wineglassful of sugar and water, four times a 
day. 

LAXATIVES FOR PUERPERAL WOMEN.;] 

PROF. DR. FORDYCE BARKER, M. D., NEW YORK. 

Our author opposes the indiscriminate dose of castor-oil, and 
very truthfully states that it often excites hemorrhoids. He highly 
recommends the following pills : 

287. I£. Ext. colocynth co., 9j 

Ext. hyoscyami, gr.xv 

Pulv. aloes soc, gr.x 

Ext. nucis vomicae, gr.v 

Podophyllin, 

Pulv. ipecacuanhas, aa gr.j. M. 

Ft. — Pil. no. xii. 

Two of these usually secure the desired evacuation of the 
bowels. One of these may be taken daily to keep the intestinal 
canal free from fecal accumulations. 

When there are flatulence and severe after-pains in consequence 
of constipation, he recommends the following : 

288. fy. Ext. sennae fluid., 

Syrup, zinziberis, aa f.5vj 

Tinct. jalap, f.^ss 

Tinct. nucis vomicae, gtt.xl. M. 

Sig. — A tablespoonful in a wineglassful of sugar and water. 

Diet. — Our author very positively dissents from the formerly 
pursued plan of restricting the diet of the parturient woman to 
to astand tea. He very judiciously remarks that at this epoch of 
maternity, her wearied and. exhausted system, with the additional 



308 COMPLICATIONS OF PARTURITION. 

taxation of lactation, requires food to meet the new demand for 
the nourishment of her offspring, and to restore her own strength 
and vigor. He further objects to the application of any arbitrary 
rules to all women, and enjoins the necessity of individualizing 
each case and adapting the diet to the various conditions of the 
patient. Some are very much benefited by an immediate restora- 
tion to their former diet, while others need more restrictions, and 
he adaptation of the diet to the various pathological conditions 
evinced. It should, however, in all cases be as abundant as the 
digestive organs can digest, and the assimilative organs can appro- 
priate without inconvenience, and of nutritious quality. 



CHAPTER III. 

DISEASES OF THE MAMMARY GLANDS 'AND 
OF LACTATION. 

Mastitis i Inflammation of the Breasts — Mammary Tumors — Mam- 
mary Neuralgia (Mastody/iia) — GalactorrJiea — Agalactia and 
O ligalactia — Diseases of the Nipple. 

MASTITIS AND MAMMARY ABSCESS. 

PROF. FORDYCE BARKER, M. D., NEW YORK. 

This author endeavors to abort the abscess by tincture of iodine 
painted over the inflamed breast. 

If unsuccessful in this he applies, over the breast, bread and 
milk or linseed meal poultices as hot as can be borne. Usually 
he prefers warm water dressings made by soaking two folds of lint 
in warm water, and these covered over by oiled silk. 

He denounces the routine practice of rubbing the breast in mas- 
titis as absolutely pernicious. 

As soon as the abscess points and the fluctuation can be 
detected, it should be opened in the most dependent point, care- 
fully avoiding, however, the areola. 

To relieve pain and procure rest, he gives ten grains of Dover's 
or Tully's powder. 

When there is an epidemic or endemic tendency, he avoids all 
depressing agents and gives full doses of quinine. 

In the treatment of the sub- glandular form the same general 
principles should govern us as to constitutional measures, as in 
the subcutaneous variety. 

He has no confidence in any topical treatment. The sole reme- 
dial measure- of value, is to secure the early discharge of the pus 
by incision. If the conditions of the case will admit of an election, 
the opening should be made at some inferior point in the circum- 

(3°9) 



510 DISEASES OF MAMMARY GLANDS AND LACTATION. 

ference of the breast, so as to prevent secondary inflammation of 
the glandular structure or of the subcutaneous areolar structure. 
Sometimes the signs of sub-glandular abscess existed, but no fluc- 
tuation ; he has detected the presence of pus by lifting up the 
gland from the thorax and passing between them an exploring 
needle. He then makes a sufficiently large incision with a long 
tenotomy knife. But if the abscess point on the anterior surface, 
then the opening must be made where the fluctuation exists, and 
care must be taken to prevent its closure before the pus is all 
discharged, by the insertion of a tent. 

Glandular inflammation or mammary adenitis presents two 
types; one rapid in its course, in the other the inflammatory pro- 
cesses are in tardy succession. In the former, resolution may be 
secured in a month; in the other, the period of several months 
may be required. 

The first requires vascular sedatives, saline laxatives, anodynes 
and an antiphlogistic regimen; while in the other, tonics, stimu- 
lants and nutritious diet are indicated. Nursing must be forbidden, 
as the pain and excitement thereby produced will aggravate the 
inflammatory condition. If, however, the secretion of milk be ac- 
tive, accumulation of this fluid must be avoided, the breast must 
be disgorged by artificial means. Rub the breast with the hand 
lubricated with sweet oil until the breast is soft and all nodulated 
indurations have disappeared. To prevent the return of the lacteal 
engorgement, he then covers the breast with the extract of bella- 
donna, softened with a little glycerine. If these means do not 
secure resolution, the abscess must be opened when the presence 
of pus is determined. Then by adhesive straps applied so as to 
support the breast and firmly compress it from circumference to 
the centre, he secures the relief of engorgement of other lobules, 
the removal of indurations, the prevention of purulent infiltration 
into the adjacent areolar tissue, and the formation of obstinate fis- 
tulous sinuses. 

PROF. W. S. PLAYFAIR, M. D., LONDON, 

Urges that much may be done to prevent abscess by removing 
engorgement of the lacteal ducts when threatened, by gentle hand 
friction with warm oil. Combat feverish ness by gentle salines, mi- 
nute doses of aconite, and large doses of quinine, and relieve pain 
by opiates. Confine the patient to bed, and support the breast by a 



MASTITIS. 3 11 

lieve 



suspensory bandage. Warmth and moisture are best to rel 
local pain, as hot fomentations, light Linseed meal poultices, or 
bread and milk ; and the breast maybe smeared with extract of 
belladonna rubbed down with glycerine, or the belladonna lini- 
ment maybe sprinkled over the poultices. Generally the pain 
produced by nursing is so great as to prevent the child being put 
to that side, and the tension must be relieved by poultices. Wh< n 
pus forms, remove it as soon as possible; nothing is to be gained 
by waiting till it nears the surface; delay leads to greater spread of 
the disease. 

The antiseptic method of operation should always be employed, 
as thus, in place of weeks or months, the abscess will be closed in 
a few days. Mr. Lister's method is so perfect that no more can 
be desired. "A solution s of one part of crystalized carbolic acid 
in four parts of boiled linseed oil, having been prepared, a piece of 
rag from four to six inches square is dipped into the oily mixture, 
and laid upon the skin where the incision is to be made. The 
lower edge of the rag being then raised, while the upper ca\>^c is 
kept from slipping by an assistant, a common scalpel or bistoury 
dipped in the oil is'plunged into the cavity of the abscess and an 
opening about 3^ of an inch in length is made, and the instant the 
knife is withdrawn, the rag is dropped upon the skin as an anti- 
septic curtain, beneath which the pus flows out into a vessel 
placed to receive it. The cavity of the abscess is firmly pressed, 
so as to force out all existing pus as nearly as may be (the old fear 
of doing mischief by rough treatment of the pyogenic membrane 
being quite ill-founded) ; and if there be' much oozing of blood, or 
if there be considerable thickness of parts between the abscess 
and the surface, a piece of lint dipped in the oil is introduced into 
the incision to check bleeding and prevent primary adhesion, 
which is otherwise very apt to occur. The introduction of the lint 
is effected as rapidly as may be, and under the protection of the 
antiseptic rag. Thus the evacuation of the original contents is 
accomplished with perfect security against the introduction of liv- 
ing germs. This, however, would be of no avail unless an anti- 
septic dressing could be applied that would effectually pre.vcnt the 
decomposition of the stream of pus constantly flowing out beneath it. 
The following may be relied upon as trustworthy; about six tea- 
spoonfuls of the above-mentioned oil arc mixed with carbonate of 
lead to the consistence of a firm paste; it is, in fact, glazier's putty 



312 DISEASES OF MAMMARY GLANDS AND LACTATION. 

with the addition of a little carbolic acid. This is spread upon a 
piece of common tin-foil, about six inches square, so as to form a 
layer about a quarter of an inch thick. The tin-foil is placed upon 
the skin so that the middle of it corresponds to the position of the 
incision, the antiseptic rag being removed the instant before. The 
tin is fixed securely by adhesive plaster, the lowest edge being 
left free for the escape of the discharge into a folded towel placed 
over it, and secured by a bandage. The dressing is changed once 
in twenty-four hours, but if the abscess be large, it is prudent to 
see the patient twelve hours after it has been opened, when, if 
the towel be much stained with discharge, the dressing should be 
changed to avoid subjecting its antiseptic virtues to too severe a 
test. After this one daily dressing is enough. The changing of 
the dressing must be done as follows : A second piece of tin-foil 
is spread with the putty, a rag is dipped in the oil and placed on 
the incision the moment the first tin is removed. This guards 
against the possibility of mischief occurring during the cleansing 
of the skin with a dry cloth, and pressing out any discharge which 
may exist in the cavity. If a plug of lint was introduced when 
the abscess was opened, it is removed under cover of the rag, 
which is taken off at the moment when the new tin is applied. 
The same process is continued daily until the sinus closes." 

In long continued suppuration, methodical strapping of the 
breast with adhesive plaster, so as to afford steady support and 
compress the opposing surfaces, will be best. The sinus may be 
laid open, or injected with tincture of iodine or other stimulant. 
Support the system with food, stimulants, iron and quinine, as 
indicated. 

PROF. F. CHURCHILL, M. D., DUBLIN. 

Bleed if the fever is high, or leech and follow with a large soft 
poultice or fomentation. A convenient and simple mode of apply- 
ing warmth, is to immerse a wooden bowl in hot water, and having 
wrapped some flannel around the breast, place it in the bowl. 
Purge briskly with salines, to which add a little tartar emetic. 
The latter may be continued in doses of one-sixteenth grain every 
hour, to "induce slight nausea, and generally in twenty-four hours 
the symptoms are mitigated, and the breasts smaller and softer. 
Diet bland and fluid. If an abscess is unavoidable, favor it and 
open early 



MASTITIS. 313 

J. S. PARRY, M. D., PHILADELPHIA, 

At the Philadelphia Hospital, urged the use of a fever mixture 
with ipecacuanha % or even tartar emetic, in a dose large enough 
to nauseate. This would be followed by relief of pain, fall of tem- 
perature and pulse. Where the subcutaneous areolar tissue is in- 
volved, iodine and astringent lotions are very useful. Put the iodine 
on freely, and then cover the treasts with cloths wet with acetate 
of lead lotion and opium. Give narcotics for pain and sleep. Dr. 
P. believes that rubbing the breast is an irrational process, and that 
milk accumulated in the breasts is not injurious. It is not a cause 
of mastitis. He would delay opening the abscess when formed, 
and the popular idea that an abscess should "be ripe" before it is 
opened, is not entirely without foundation. He waits until the pus 
has approached the surface, and is almost ready to open sponta- 
neously. 

Where sinuses form, carry a stick of nitrate of silver to the 
bottom, and leave it there, or inject iodine, sulphate of zinc, or 
copper. 

' Q. C. SMITH, M. D., CALIFORNIA. 

289. I£. Olei lini. f.§iv 

Chloral hydratis, . §ss. 

Powder the chloral very fine, then mix it thoroughly with the 
oil. Apply, spread thickly, on a piece of soft woolen flannel, a 
little larger than necessary to cover the breast, with a central 
opening through which the nipple may protrude. 

Apply as warm as can be borne, and keep warm whilst it re- 
mains applied by warmed sacks of chamomile flowers or hops. The 
plaster should be renewed every four to six hours, until all pain, 
swelling and induration are relieved. {Pacific Medical Journal, 
May, 1878.) 

In acute mammitis, a number of observers have reported striking 
success with the flofce root : 

290. ]£. Fluidi extracti phytolaccae, q. s. 
Twenty drops every three hours. 

Others have seen benefit from : 

291. I£. Tincturae belladonnas, 

Tincturae digitalis, aa f.3j M. 

Ten drops every three or four hours. 



3 H DISEASES OF MAMMARY GLANDS AND LACTATION. 

In chronic mammitis, Prof. Hunter McGuire, M. D., of Rich- 
mond, Va., condemns ( Virginia Medical Monthly, September, 1875), 
the severe and needless practice of slitting up the sinuses, or of in- 
jecting them with stimulating fluids. Nearly every case can be 
cured by proper bandaging with adhesive plaster. 

Cut the plaster into strips from four to six inches in length, and 
from a half to three-quarters of an inch in width, according to the 
size of the breast. After warming the plaster, apply one end of a 
strip to the circumference of the gland, near the axilla. Take 
another strip of the same length and width, and fasten its end to 
the inner circumference of the breast, near the sternal bone. The 
ends of the two strips of plaster thus applied are held in place by 
an assistant, while the surgeon takes the free extremities of the 
strips, and drawing them toward each other, that is, drawing the 
breast from its circumference toward its centre, crosses the strips 
and fastens them. Two more strips are then applied just below, 
and lapping slightly the first two pieces. Continue in this way till 
the whole breast is covered (somewhat upon the same principle 
and manner that we use strips in art indolent sore on the leg), 
leaving the nipple and fistulous orifices uncovered. A piece of 
moistened lint is placed over the sinuses to catch the pus which 
escapes. 

ASHBURTON THOMPSON, M. D., LONDON, 

Speaking of mammitis (Medical Times and Gazette, January, 
1875), mentions two modes of treatment, (1) the administration of 
tincture of aconite, and (2) the total abstention from fluids during 
the necessary number of days. By giving minim doses. of aconite 
every hour, he had succeeded in cutting short inflammations of 
the breast which there was no doubt would otherwise have run on 
to suppuration very frequently ; indeed, in three cases out of four. 
In cases of still- birth he had hitherto found abstention from fluids 
sufficient in every case to avoid every kind of mammary disturb- 
ance. Ice was allowed in moderate quantity, and no other fluid, 
from the time of delivery until the fourth or fifth day, when the 
breasts generally return to their normal state of quiescence. The 
deprivation of fluid caused but little distress. 

JOHN B. C. GAZZO, M. D., THIBODAUX, LA., 

In Med. and Stir. Reporter, May 6, 1876, gives his treatment as 
light diet, alteratives, and tonics, a compress moistened with the 



MASTITIS. 315 

linimentum, ammoniac iotlidi et chloroformi applied to the breast 
as high as the axillae, carefully enveloping the diseased mammae, 
covering the compress with oiled silk, and keeping the whole in a 
suspensory bandage; during the first day renew the application 
once in two or three hours. This proceeding must be repeated 
every day until the swelling disappears, which is, usually, the 
second or third day. The liniment of chloroform and iodide of 
ammonia should be applied the moment that pain and engorge- 
ment of the mammary glands manifest themselves; it will then act 
as an abortive in suppressing incipient pain, and thereby prevent 
the inflammation which threatens the mammary structure. The 
inflammatory period of the mammary is not only shortened, but 
the entire duration of the disease is diminished by at least one- 
half. After the large, .heavy and inflamed mammae become 
perfectly flaccid, completely cool, and the flow of milk begins 
anew, allowing of the freest handling, omit the application. The 
only inconvenience attending it is the irritation produced upon the 
skin; this, however, is more than compensated for by the deriva- 
tive action of the iodide of ammonia and chloroform upon the 
inflamed breast, which will very often, in all probability, prevent 
abscess and suppuration. 

In addition to appropriate medical remedies, the following pre- 
scriptions were employed with the happiest results ; the first, an 
excellent detergent and purifier of the blood, preventing the form- 
ation of matter within the glandular system ; and the second, a 
tonic in restoring the mucous membranes. 

292. ^. Potassae chlorat., 3ij 

Aquae destil., f.gvlij 

Acidi. hydrochlorici, gtt.xxx 

Syrupi aurantii, f.^iij. M. 

Sig. — One tablespoonful every two hours. 

293. fy.. Cinchonas sulph., 3ij 

Ouinias et ferri citras., 3iij 

Tinct. ferri. chloridi, f.3ij 

Syrupi sennas, f . § \" i j . 

Sig. — One tablespoonful three times a day, after diet or meals. 

The liniment of iodide of ammonia is prepared as follows: 

294. I£. Iodinii, 5"j 

Ammoniae iodidi, 5ij 

Chloroformi, 

Olei olivae, aa f.^x 

Glycerinae, f.§v. M. 

Dissolve the first two by rubbing in the chloroform ; then add the 
olive-oil and glycerine. 



3 16 DISEASES OF MAMMARY GLANDS AND LACTATION. 

C. B. KEIPER, M. D., INDIANA. 

The first fifteen years of practice he used belladonna poultices, 
and so forth. Now and then he would have a suppurating breast; 
and in cases that did not suppurate, it would require from six to 
ten days to subdue the inflammation. 

In the last fifteen years he made no other applications than cold 
water and muriate of ammonia ; two ounces of muriate of ammon- 
nia to a half gallon of cool water. Where ice cannot be had, 
put the solution in a tin bucket, and place this bucket in an- 
other one of cool water, so as to keep it at a low temperature (in 
city practice ice may be employed); then take two pieces of cotton 
goods, each about twenty inches square, and double each one four 
times, and then cut a hole in the centre about two inches in 
diameter, so as to protect the nipple, and dip these in the solution, 
and apply to the parts affected; removing every twenty minutes, 
to immerse anew in the solution. This continue till the inflam- 
mation is subdued, which generally requires from one to three, 
days. 

HUGH MILLER, M. D., OF GLASGOW. 

In cases where acute congestion occurs in the mammary glands 
when commencing to secrete, this author (Edinburgh Med. Jour- 
nal, December, 1877), employs with great success a preparation of 
belladonna. It is an alcoholic extract of double the usual strength, 
kept fluid by collodion. Camphor is combined with it for the pur- 
pose of aiding to arrest the natural mammary secretion. This 
preparation is painted on the breasts much in the same way that 
you would use blistering fluid. No rubbing in is necessary. The 
fluid dries quickly, is much more cleanly for the patient, has a 
less offensive odor than the ointment, and in his experience, it is 
more reliable in its action. 

This liquid preparation is painted over the affected parts of the 
breast night and morning, until the acute symptoms give in. In- 
deed, it can only be of service as a good local sedative when the 
free and frequent application of it to the affected part has been 
persevered in until decided results are secured. He has used this 
preparation with very satisfactory results. Whether the inflam- 
matory irritation accompanying the onset of the lacteal secretion 
had for its exciting cause exposure to cold, inflamed nipples, or 
obstruction in the lacteal ducts, the preparation has always seemed 
to be of value. He has also used the preparation beneficially by 



MASTITIS. 317 

applying it to both breasts every day when the mother did not in- 
tend to suckle her child : and is satisfied that it may be safely re- 
lied upon for restraining the secretion of milk, and acting on the 
walls of the arterioles so as to prevent engorgement. It has the 
advantage over the old plan of evoporating lotions, in that it is 
more cleanly, and is more comfortable to the patient. When the 
remedy is employed to prevent the secretion of milk forming at 
all, it is best to begin applying the liquid immediately after the 
birth of the child. 

EDGAR KURZ, M. D., OF TUBINGEN. 

In the lying-in hospital at Tubingen, this author treated the very 
frequent cases of commencing mastitis in the following manner: 
When the breast is tense; with milk and becomes hard and sensi- 
tive, it frequently suffices merely to restrict the diet of the patient, 
and to remove the superabundant milk by nursing several children, 
or drawing it out with one of the various appliances devised for 
the purpose, or by gently expressing it. When the affection has 
advanced a step farther, and the breast is much swollen and lumpy, 
and the skin reddened, and suppuration appears imminent, it is 
necessary to adopt energetic measures. The diet is still more re- 
stricted, laxatives are given, the breast is securely bound up by a 
cloth, without, however, exerting compression, which is suitable 
only for chronic cases, or the residual nodosity following acute 
mastitis. The main point of the treatment is the application of cold, 
which in light cases consists merely in iced compresses ; in severe 
cases in the unremitting application of a bladaer filled with ice. 
The often intolerable pain, which is increased by compression, 
yields rapidly to this treatment; the tension decreases, suppuration 
is prevented, and in a few days even mastitis may be cut shoit in 
this manner. During two years of this treatment, not one case of 
mastitis terminated in suppuration, whilst under compression it 
frequently occurred. 

PROF. F. WINCKEL, M. D., ROSTOCK. 

Applies dry heat if veiy acute pain persists after the use of com- 
presses of cotton batting, cold compresses, or the ice-bag. When 
headache is severe and the tongue coated, he gives large doses of 
iodide of potassium To reduce the thickness of the skin and 
expedite the evacuation of pus, he paints with iodine. Evacuate 
pus promptly. 



3 1 3 DISEASES OF MAMMARY GLANDS AND LACTATION. 

When a portion of the gland is tender, swollen, and the surface 
red, give the breast as much rest as possible, by less frequent 
nursings, or entire cessation on that side. Use compresses, wet 
with lead water, night and day, renewing them every few minutes, 
supporting the breast. Keep the bowels free. Continue until 
the nodules disappear, or alternate the lead with tincture of iodine, 
if there is reason to believe that an abscess is forming. Pointing 
of pus is thus hastened. A plaster of Paris bandage applied to 
the breast is excellent after evacuation of pus, as it insures uniform 
compression of the gland. Change it every two or three days. 
Other methods have been employed, but this should completely 
supersede the use of warm poultices. 

To remove any lacteal nodes, mercurial ointment or iodide of 
potassium may be rubbed on, or the parts covered with emplast. 
saponis., emplast. cicutae, or emplast. melliloti, and iodine, given in- 
ternally, the child having been weaned. 

J. L. POWERS, M. D., REINBECK, IOWA. 

This writer, in the Medical Brief, October, 1878, uses tobacco 
salve spread upon drilling, the size of the breast, with a hole in 
the centre for the nipple. 

Internally, when inflammatory symptoms are marked : 

295. R. Spt. ether, nit., f.fss 

Tr. veratri virid., f.5ss 

Aquae, f.giij. M. 

Teaspoonful every hour or two, until it produces a sedative effect, and 
then less frequently. 

With concentrated tincture of phytolacca, fifteen to twenty drops, 
and this used persistently, he believes an abscess may be avoided. 

RESUME OF REMEDIES. 

Acetum. The application of a cloth wrung out in hot vinegar, which is 
then covered with a bowl moderately heated, is a popular means 
of aborting threatened inflammation of the breasts. 

Aconitum, in minim doses of the tincture, is recommended by Dr. Thomp- 
son (p. 314). 

Ammonii Murias, as a resolvent local application, has been found very 
efficient (p. 316). 

*Bellado?ina. In recent induration and inflammation of the breasts, re- 
markable effects are produced by belladonna in arresting the se- 
cretion of milk. Either as plaster or ointment, or also inter- 
nally, its use should not be omitted. 



MASTITIS. 519 

Chloral is applied locally by Dr. Q. C. Smith (F. 289). 

Coniutn. In chronic engorgement or hyperplasia of the breasts, the pro- 
longed use of conium internally has a decided influence in re- 
ducing the size. 

Digitalis in inflammatory states may sometimes be advantageously com- 
bined with belladonna (F. 291). 

Ergota moderates the secretion of milk, and has been used to prevent 
mammary abscess and engorgement of the breasts during 
weaning. 

Iodinii Tinctura, in the chronic forms of engorgement, is a valuable re- 
solvent. 

Petroselinuin. Freshly bruised parsley leaves are a popular remedy in 
commencing mammary inflammation at the beginning of lacta- 
tion. 

* Phytolacca Decandra, is known popularly as the " garget weed " and is 
extensively used for garget (mammary inflammation) in cows. 
Considerable evidence has been adduced that it possesses equal 
value in the human female. It is given in doses of gtt.xx of 
the fluid extract of the root every three or four hours (Am. 
Jour. Med. Sciences, 1873, p. 275 ; Med. and Surg. Reporter, 
Jan., 1875). Dr. J. G. Allen, states (Am. Jour. Obstetrics, 
Oct., 1879), tnat it ^ s not °f value where the mammitis begins 
at the nipple or only involves small lobes of the gland; but 
where the whole or a large portion is swollen and congested, 
and in the condition of congestion that sometimes results from 
an attack of ephemeral fever, the phytolacca is almost a spe- 
cific. 

Phmibi Acetas. Dr. Huebner, of Dresden, recommends the constant 
application of lukewarm lead-water in compresses, followed, if 
required, by strapping of the breast and free incision. 

Plumbi Iodidum. The discutient powers of this agent may be advanta- 
geously called into play in chronic engorgement of the mammary 
glands 

Stramonium. The •fresh leaves of stramonium, made into a cataplasm and 
applied externally, have been found successful for discussing 
indurated lacteal glands in the breasts of nurses (Phillips^. 

Tabacum, in the form of ointment, gr.xxx to lard 5j, has long been used 
in some parts of this country as a domestic application to in- 
flamed and " caked " breasts. 

GENERAL MEASURES. 

Cold. Some writers are very positive in praise of cold applications in 
threatened inflammation of the mammary gland. Pounded 
ice is placed in a bag and laid directly upon the gland, to be 
renewed from time to time. The pain and swelling is said to 
abate promptly, "within an hour," and in a few days the in- 
flammatory action has quite disappeared (see p. 317). 

Cofnpression is highly praised by most authorities (see pp. 310, 312, 
314, 318). Dr. Koening says that in mammary lymphangitis 
it is "infallible." The method which he employs (London 



320 DISEASES OF MAMMARY GLANDS AND LACTATION. 

Med. Record, April, 1877, is the following: The diseased 
breast is covered with a layer of cotton wool, and a bandage is 
applied which is known in minor surgery as the bandage of 
Mayor, or the triangular bonnet of the breast. The form of 
the bandage is a triangle, a yard in length from one extremity 
to the other, and fifty centimetres (nearly twenty inches) from 
the apex to the base. The base of the triangle is placed ob- 
liquely under the diseased breast, then one of its extremities is 
directed under the corresponding armpit, and the other over 
the opposite shoulder, and there united behind the shoulder- 
blade The apex of the triangle is then lifted in front of the 
diseased breast, it is carried over the corresponding shoulder, 
and firmly fixed behind. 

Sometimes a linseed poultice is at the same time applied on 
the inflamed. part. 

The effects of treatment thus arranged are almost marvelous ; 
the pain is immediately calmed, the inflammatory redness, and 
the oedema are diminished at the end of a very short time. 
Heat is more popular than cold as a means to effect resolution. Hot vin- 
egar, lead-water, etc., warm poultices, heated bowls or plates, 
etc., are familliar applications, and often successful. 



MAMMARY TUMORS. 

DIAGNOSTIC POINTS. 

The diagnosis of mammary tumors is confessedly difficult. We 
give from various surgical authorities a few points to serve as diag- 
nostic landmarks. 

I. The tumor presents itself as a small nodule in the breast. 

It may be merely a benign chronic mammary tumor (adenoma), 
or the beginning of sarcoma, or scirrhus. 



Adenoma. 

Patient under thirty and 
single. 

Tumor dense, but elastic 
and movable under ihe 
skin, and movable on 
the deeper part of the 
breast. 

Pain, if present, of a neu- 
ralgic character, and 
worse at the menstrual 
period. 

Skin and lymphatics 
never involved. 



Grows very slowly, 

varies in size. 
Nipple not retracted. 

No family history. 



and 



Sarcoma. 
Patient any age. 

Tumor elastic and mov- 
able, but rapidly in- 
volving the surround- 
ing tissues. 

Pain not severe as a rule. 



Skin eventually in- 
volved, but no lym- 
phatic enlargement. 

Grows very rapidly, and 
apt to recur locally. 

Nipple often exudes 
fluid. 

No family history. 



ScirrJuts. 
Patient over thirty. 

Tumor hard, and at- 
tached to the deeper 
part of the breast, 
though at first mova- 
ble beneath the skin. 

Pain severe, and of a 
sharp, lacerating char- 
acter, and shooting 
down the arm. 

Both skin and lymphat- 
ics involved early. 

Grows rapidly, except in 

old people. 
Nipple often retracted. 

Often hereditary. 



Of these signs, the enlargement of the lymphatic glands of the 
axilla and neck is the most important point in the diagnosis of 
scirrhus. 

Adenoma generally occurs in the breasts of young, healthy 
women, during their period of developmental perfection. Among 
married women it often occurs among those who are suckling. It 
usually grows slowly, and as it enlarges, pushes the breast aside;, it 
never infiltrates it. It may grow to a great size, and stretch the 
skin even to the point of rupture; but the skin is never infiltrated,, 
nor the tissues beneath. The tumor is encapsuled, and usually 
movable, and can be readily turned out. It is never associated 
with any secondary glandular enlargement. 

2. Tlie tumor is elastic. 

21 (321) 



322 DISEASES OF MAMMARY GLANDS AND LACTATION. 

Its contents should be drawn to the extent of a drop or two 
by a needle, and examined. If the fluid proves to be : 

(a) Pus, the case is one of abscess. 

(b) Milky fluid, it is galactocele. 

(c) Clear fluid, it is simple cyst. 

(d) Dark fluid, it is compound cyst or sarcomatous cyst. 

(e) Clear fluid 'containing microscopic hooklcts, it is hydatid. 
3. The tumor is large, clastic, and rapidly growing. 

It may be : 



Encep haloid Cancer. 
No cysts present. 
Lymphatic enlargement in the axilla 

and neck. 
Skin infiltrated and thickened, often 

with small flattened nodules. Veins 

enlarged. 



Benign Cystic Growth. 
Cysts present. 
No lymphatic enlargement. 

Skin stretched and thin, so as event- 
ually to give way. Veins about 
natural. 



Hysterical Breast. This is a rather rare affection. Its invasion 
is often sudden, and the malady rapidly reaches its maximum of in- 
tensity. It is ushered in by a sense of uneasiness and formication, 
which is soon transformed into lancinating pains, becoming almost 
intolerable. In some cases the skin is changed, in others it becomes 
red, hot and swollen, and remains so till the end of the exacerbation. 
In the meanwhile, the gland enlarges to an enormous size. The 
ovaries are sometimes in sympathy. This condition lasts from 
one to three days. These troubles generally coincide with the 
•period of menstruation or an hysterical attack. 

PROF. SAMUEL D. GROSS, M. D., PHILADELPHIA, 

Considers the great object of the constitutional treatment in carci- 
noma, as the maintainance of the general health as near the nor- 
mal as possible, and the best means are a proper regulation of the 
diet, bowels, and secretions, the avoidance of pain, plenty of sleep, 
and a contented mind. The diet should be that which agrees with 
the stomach, and affords the best nourishment in the smallest com- 
pass. The plethoric should have farinaceous food principally, 
while the anemic require meat, and even malt liquors or stimu- 
lants. 

Pain may be allayed by anodynes in suitable doses. A hot, dry 
skin requires pulvis ipecacuanhae comp. and a few grains of blue 
mass ; change of air and scene, as to the sea coast, are often bene- 
ficial. Specifics fail to cure, though they often improve the health. 



MAMMARY TUMORS. 323 

Of these we have quinine, bark and iron, as the best. Arsenic is 
useful, and the best form is the iodide, 1-16 of a grain three times 
a day. 

The topical treatment should be suspension of the organ, and 
the removal of all pressure. Leeches may be applied when there 
is inordinate vascular excitement, especially if the patient is ple- 
thoric, and the flow of blood may be encouraged for some hours 
by cloths wrung out of hot water. Afterwards the parts may be 
kept wet with lotion of acetate of lead, and opium. Light emol- 
lient poultices are useful, and may be medicated with lead, opium, 
dilute tincture of iodine, etc. Anodyne plasters of opium, cicuta, 
stramonium and belladonna, are comforting. The soap, compound 
galbanum and DeVigo's plaster, are useful if well sprinkled with 
morphia. s 

When ulceration occurs, the indications are to moderate dis- 
charge, prevent hemorrhage, relieve pain, allay fever, and sustain 
the strength. Here we may use subsulphate of iron, anodynes, La- 
barraque's solution, or permanganate of potassa, frequent ablutions 
and good diet, with stimulants. If there is copious hemorrhage, 
acupressure may be employed. 

Excessive swelling of the arm may be relieved by the roller 
bandage and steady elevation of the limb. (The strong elastic 
bandage will in these cases be found of very great value. — Ed.) 

Itching of the skin may be relieved by zinc ointment and Gou- 
lard's extract. 

Mammary hypertrophy may be met by iodine, externally and in- 
ternally ; gentle and protracted ptyalism ; the steady and persist- 
ent exhibition of chloride of ammonia, 10-20 grains three times 
a day; the relief of weight and tension. Extirpation must be em- 
ployed if the tumor is large and the health is failing. 

Milk tumors should be injected with a stimulant, as dilute tinct- 
ure of iodine, and the seton or tent may be employed, with care 
that the inflammation does not run too high. When the tumor 
is solid, it may be excised. 

(We have seen a number of such tumors, and have invariably 
advised non-interference, and have never known bad results to 
follow. — Ed.) 

Serous cysts will sometimes disappear under the steady use of 
discutients, as a strong solution of chloride of ammonia, or equal 
parts of alcohol and spirit of camphor, with a small quantity of 



324 DISEASES OF MAMMARY GLANDS AND LACTATION. 

Goulard's extract. Or a cure may be effected by the seton, tent, or 
iodine injections. When the cyst is old, large, or partially solidi- 
fied, excision is necessary. 

The only remedy for hydatid tumors is excision. Relapse does 
not occur. 

For fibroid and adenoid tumors, sorbefacients and compression, 
with iodine internally, may be tried in the earlier stages; after- 
wards excision is the only reliable means. 

PROF. JAS. Y. SIMPSON, M. D., EDINBURGH, 

In speaking of carcinoma of the mamma, says the two serious 
objections to the knife are, the probability of a relapse, and the 
danger of the operation. Hence the treatment by caustics requires 
to be considered ; these give less pain, and the wound heals more 
readily than that left by the knife. Nor is the result less complete, 
as "there is good reason to believe that the modifying influence 
of the caustic, probably sometimes extends also to cells and 
structures which may be wholly, or only in part, affected and mor- 
bidly altered, and which lie beyond the line of immediate extirpa- 
tion." Caustics may be applied to all forms of cancer. The 
remedies from which the best have been obtained, are the chloride 
of zinc used in the form of a paste with starch or flour, the perni- 
trate of mercury, and the sulphate of zinc. The latter, when dried 
and powdered, is a very powerful caustic. Prof. Simpson applied 
it in several cases with complete success. To apply it to the base, 
or into the interior of a tumor, it may be mixed with sulphuric 
acid. 

The greatest advance in this treatment has been in the more 
clear and practical views as to the mode of using the caustics, 
their introduction into the centre or the base, so as to produce 
quickly mortification of the entire mass. With the sulphate of 
zinc, an ordinary quill-pen may be used. Saturate strong sulphuric 
acid with the zinc dried and powdered ; dip the pen into it, and 
lay the caustic in a number of lines across the tumor. Soon the 
skin is killed in the course of these lines; then scratch the filled 
pen along these lines, and the skin is readily cut through. Fill 
the fissures with the paste, and every day or two renew it, thus cut- 
ting down. In the first application, he usually made a fissure of a 
fourth or three-eighths of an inch in depth. Thus, in five or six 
days, a good-sized tumor may be removed. Dress with black 



MAMMARY TUMORS. 325 

wash, chloride of zinc, sulphate of zinc, or nitrate of silver. The 
healthy skin at the edge of the mass usually granulates, and is 
partially cicatrized before the dead tumor is separated. 

MAISONNEUVE, of Paris, recommends " caustic arrows;" these are 
pieces of paste of chloride of zinc, in the form of small cones, 
sharpened to facilitate their entrance into the mass. He usually 
punctures the tumor all around, and introduces an arrow deeply 
into each wound. Or, he introduces, parallel to each other, a 
number of flattened pieces of the paste. 

Perhaps, as these cause severe hemorrhage, arrows of chloride 
of zinc and perchloride of iron might answer better. 

The injection of a sulphate of zinc lotion, or of some other 
equally powerful caustic, by means of a small syringe, has been 
tried, but not with the best results as yet. Perhaps, if a larger 
tube were used, and such articles as the perchloride of iron 
thrown by one opening, but at different angles, into the mass, 
more beneficial results might be obtained. 



MAMMARY NEURALGIA (MASTODYNIA). 

Occasionally during lactation, the mammae are the seat of in- 
tense neuralgia, compelling the woman to abandon nursing unless 
relieved. For this condition Dr. Fordyce Barker has found qui- 
nine in full doses twice a day an efficient remedy. 

It is not uncommon in the early months of pregnancy, and also 
in non-pregnant women of a hysterical constitution, to find in- 
stances of neuralgic pain in the mammae. In most of these cases, 
narcotic fomentations, and opium internally, will give relief. Occa- 
sionally the hypodermic use of morphia will be requisite. 

Tanner speaks well of the valerianate of iron or of zinc ; and 
also of the tincture of actea racemosa, combined with small doses 
of aconite where there are signs of engorgement. Cod liver oil 
has relieved some cases which have resisted all other remedies. 
He has found quinine chiefly serviceable where some degree of 
periodicity is manifest. Mental relief will always be given by 
calming the patient's fears as to the nature of the disease, since 
directly a nervous woman has pain in the breast, she usually con- 
cludes it must be due to cancer. 

Dr. Anstie says that in some cases, discontinuance of nursing 
has been found necessary, but generally, complete rest, protection 
of the breast from air and friction, and the hypodermic injection 
of morphia will rapidly relieve. Very frequently it is the result of 
malnutrition, and is then readily and permanently cured by an 
abundance of easily digested, nutritious food. As medicaments, 
we may use the tincture of cliloride of iron in full doses, and still 
better, combine it with strychnia, 10 minims of the iron to -^ grain 
of the strychnia. Arsenic, phosphorus, and belladonna have each 
proved extremely useful. 

(326) 



GALACTORRHEA. 

An excessive flow of milk, while very exhausting to the woman, 
is exceedingly liable to cause positive and permanent ill health, 
Many authors relate cases of insanity which were undoubtedly 
due to an excessive flow of milk inducing anemia; and the anxiety 
of the mother to nurse her child, fearing that her increasing weak- 
ness would incapacitate her, lias culminated in mania, perhaps 
causing her to take the life of her offspring. The milk itself is 
apt to be thin and watery, deficient in the vital constituents. The 
treatment will consist in the generous support of the woman by 
appropriate food, avoidance of fluids, and the use of astringent 
tonics. If not readily checked, and the general health shows in- 
dications of being affected, lactation may be partially or wholly 
suspended. Coffee is regarded by some authorities as capable of 
suppressing the supply of milk. The editor has used it for this 
purpose, but as this was associated with other remedies, he is un- 
able to give its true value. 

PROF. WM. LEISHMAN, M. -D., GLASGOW. 

Says the quantity alone may be abnormal, and only requires inter- 
ference to guard the health of the mother from the unnecessary 
drain. This requires regulation of the woman's diet. Or in addi- 
tion to the excessive quantity, tlie bulk may be mainly of water, 
thus affecting the health of child and mother. As this is believed 
to be associated with a phthisical tendency, it would be better 
to wean the child. 

C. H. F. ROUTH, M. D., LONDON. 

This author considers the treatment as both dietetic and medici- 
nal. If the woman have suffered from menorrhagia, or other habit- 
ual discharge, and is not weak, purgatives and other derivatives 
may be used, the breast kept cool, and the child not applied more 
frequently than every three hours. It is, however, generally the 
result of weakness; hence tonics are required, especially those of 
an astringent character, as oak bark, cinchona bark, and most of the 
vegetable infusions, while the bowels are regulated by alteratives. 
Along with these give good wholesome food to improve the 
strength of the patient and the quality of the milk. Nutritive, but 
not stimulating drinks, may be allowed in moderation. 

(327) 



328 DISEASES OF MAMMARY GLANDS AND LACTATION. 

When the flow is greatly in excess, and there is danger of mis- 
chief, as inflammation or abscess, antigalactics may be necessary. 
Of these there are four: iodide of potassium, belladonna, colchicum 
and iron. Of the first, Prof. Rousset says it occasions a consider- 
able decrease of milk, and prevents or removes milk knots, if at the 
same time the child is not nursed, but the milk returns if the med- 
icine is not used longer than two or three days. The dose should 
not exceed five to eight grains daily. The secretion of milk can 
almost be completely prevented, if this drug is given on the first 
or second day after delivery. 

Belladonna appears to act differently according as it is exhibited. 
In 1829 Dr. Fifield, of Weymouth, used it to allay irritation of 
the breast. Dr. Schnur in 1834 employed a liniment of laurel 
water f.Sij, sulphuric ether f.5j, extract of belladonna 3ij, to rub 
the breasts to arrest milk abscess. Dr. Goolden employed it, 
smearing the axilla and breasts freely. It entirely relieved the 
symptoms in several cases. Several others have been equally suc- 
ceeded. Mr. W. Newman, of Fulbeck, England, used it in 
cases where the suppression was desirable because of the death 
of the child, or the necessity of weaning, or where engorgement 
supervened, and abscess threatened. He employed the extract 
softened with glycerine, and in every case resolved the engorge- 
ment, or arrested the secretion. Berry believes that belladonna 
acts primarily on the muscular fibre. The lacteal tubes, in part 
muscular, are thus dilated, and one of two things occurs. The 
milk is either absorbed, like any other effusion, by the absorbents 
or veins in situ; or, it may be drawn out. This effect is produced 
by the child, or by a poultice, which assists the dilatation of the 
external tubes. In threatening abscess, it acts as a sedative. 
Therefore he believes that it merely prevents accumulation. It 
should not be used sparingly, but freely, in the form of extract 
all over the breast, except the nipple and areola. Never fail to 
wash the nipple before applying the child. 

(I can fully substantiate the views of Dr. Routh in regard to 
belladonna, having relied wholly upon it for nearly twenty years 
in a large obstetric practice, and where a good extract was used 
and applied freely, as above, I have never known a failure. The 
secretion may be completely arrested in one breast for any cause, 
while it remains unaffected in the other. Or where abscess is 
feared, the free application from one to three days will positively 



GALACTORRHEA. 329 

relieve the engorgement, and nursing may continue as desired. I 
generally order 

296. ty. Extracti belladonnae, 3ij 

Ung. petrolei, §j. M. 

to be rubbed freely over the whole of the breast, except the nipple 
and areola. In several instances I have thus produced the toxic 
effect of the drug, but the secretion was only reduced, not entirely 
arrested, while the symptoms of abscess speedily disappeared. — 
Editor.) 

Goolden says that when milch cows eat the meadow saffron 
[colchicuni) in the pasture, their milk is immediately dried up. 

Routh believes that iron is certainly an antigalactic, especially 
if the astringent preparations are used. Mr. Stanislaus Martin, 
of Auvergne, noticed that drinking ferruginous waters caused the 
milk of animals to dry up. He tried it with a nursing woman, 
and the milk began to disappear. Dr. Richardson, of Tunbridge 
Wells, found the quantity of milk thus to be decreased in the 
plethoric, but where there was general debility, anemia, it was 
increased. 

The following is certainly effective as an antigalactic : 

"Beat up the yolk of an egg to a froth, add olive-oil and honey, 
of each two tablespoOnfuls, thicken with flour to the consistence 
of an ointment, spread it on a rag, and lay it on the breast; change 
night and morning, and wash the bosom before each renewed 
application." 

Gardner and Doutrepoint, speak well of conium. Others re- 
commend tobacco and peppermint. 

Where the flow is too free by reason of relaxed fibres of the 
parts, etc., astringent tonics may be given, but we require other 
aid. Cold water may be applied two or three times daily to the 
nipple, not to the breast, and very slightly retractile collodion 
may be brushed around the nipple, and not upon it. The gutta- 
percha collodion is preferable; it constringes the nipple, and thus 
leaking is prevented; decoction of oak-bark or alum, with the 
addition of a little gum, is a good local application. Internally, 
mix vomica or strychnine may be given, with or without quinine. 
It strengthens muscular tone and nervous force. 

JOHN WM. LANE, M. D., LONDON. 

(Medical Press and Circular), for more than ten years has employed 



330 DISEASES OF MAMMARY GLANDS AND LACTATION. 

the following method to prevent the secretion of milk in the breasts 
of women who may have had still-born children, or who, after 
after having nursed their child for a few months, found it neces- 
sary to wean it. 

It consists in taking a piece of emplastrum adhesivum of about 
ten inches square, round the corners, cut a hole in the centre for 
the nipple, then from the centre of each corner make a straight 
cut toward and within two inches centre of the hole; having 
now got it ready, let the patient lie on her back, her body being 
perfectly horizontal ; warm the plaster and place it over the breast, 
then strap one of the lower corners down first, draw the oppo- 
site one tightly upward and fix its place, then the other lower cor- 
ner, and lastly the opposite upper one, having drawn it sufficiently 
tight first ; now take a piece of plaster two inches wide and about 
sixteen or eighteen inches long, and put it on from below and out- 
side the breast, across, close by inside of nipple, and fasten the 
end over the clavicle; another piece may also be put on in an 
opposite direction, it being drawn over the shoulder. Of course, 
in cutting the plaster and strips, the size of the breasts must be 
taken into consideration, there being so much difference in the 
size of female breasts. 

RESUME OF REMEDIES. 

Agaricus, gr. iij. in pill, will lessen the secretion in weaning, etc. 

A lumen, in powder, boiled in milk, is an efficient popular means to "dry 
the milk." 

Atropia has been found efficient in excessive secretion of milk. 

* Belladonna is probably the most efficient drug known to check galactor- 
rhea. It should be applied locally and taken internally. When 
a woman is subject to galactorrhea during nursing, she should 
begin the application of belladonna ointment to the breasts sev- 
eral months before confinement. 

Caffea, has been found effective in the editor's experience (p. 327). 

* Camphora possesses well ascertained powers of checking the lacteal se- 
cretion, and may be advantageously combined with belladonna. 

Cannabis Indica. The volatile oil of cannabis sativa. employed in warm 
embrocations on the breasts, is said by Conteux to be the best 
of all agents to check galactorrhea and prevent mammary en- 
gorgements. 

Colchiatm. It has been observed that cows which eat the meadow saf- 
fron have their milk dry up ; Dr. Keating, of Philadelphia, has 
observed a similar effect in nursing women from the administra- 
tion of colchicum. 



GALACTORRHEA. 33 1 

Conium plasters were formerly used to dry up the milk. By a prolonged 
use of it internally, the mammary gland has been known to be- 
come atrophied, and its secretion to have been gradually sus- 
pended (Stillk). 

Ergota has a positive influence in galactorrhea. 

lod/n.'um, in small and repeated doses, will check excessive lactation. As 

an ointment to check the secretion of milk, Dr. J. L. Ludlow, 

of Philadelphia, recommends : 



M. 



Liniment um Sapono- Camphor atmn, or Opodeldoc Balsam, rubbed on the 

breasts, has been observed to lessen the secretion, probably 

owing to the campihor in it. 
Mel. In Italy, inunction of honey to the breast is popular at weaning. 
Potassii Iodidum will lessen the flow of milk. 
Rhamnus Cutharticus , in infusion, internally, is recommended by Italian 

physicians (Fonnsagrives). 
Salvia. Strong sage tea is a popular remedy to dry the milk at weaning 

time. 



297. R. Iodinii, 




gr. 


C amphorae, 






Extr. belladon., 


aa 


5j 


Cerati resinae co., 




Sj. 


Apply to the breast. 







AGALACTIA AND OLIGOGALACTIA. 

PROF. J. B. FONNSAGRIVES, M. D., PARJS. 

This writer {Therapeutique Appliquee, 1878), states that the agents 
to increase the secretion of milk find their application in three 
events : 

1. That the milk is insufficient for the child. 

2. That the secretion having become recently suppressed, an 
effort is made to re-establish it. 

3. The sudden cessation of the secretion is coincident with the 
development of symptoms more or less serious in the mother. 

1. Means to increase the milk. True galactogenic agents increase 
the quantity without diminishing the quality of the milk. Abund- 
ant and succulent food, fresh air, plenty of sleep, exercise, and if 
required, bitter tonics, are the more rational measures. In Brit- 
tany, cider, beer, and especially oatmeal porridge, have a wide 
reputation. Of drugs the Gallf.ga officinalis has been asserted on 
good authority to increase both the quantity and the quality of 
the milk. 

2 Means to re-establish the lactation. When after temporary in- 
tervention, it is desired to renew the secretion, the most efficient 
agents are: (1) Suction, either by the mouth of the infant or the 
nurse, or by one of the instrumental methods now familiar. (2) 
Topical applications. Of these the leaves of the castor oil plant, 
ricinus communis, deserve special mention. A handful of the fresh 
leaves is boiled in half a gallon of water, and the breasts are 
gently bathed and rubbed with this decoction for fifteen or twenty 
minutes; after which a poultice of the boiled leaves is laid upon 
the breast, and allowed to remain there till dry. If the secretion 
does not reappear in a few hours, this is to be repeated. (3) Far- 
adisation. The apparatus should be at moderate force, the con- 
ductors moist, the muscles of the breast should not be included 
in the current, which should be confined to the gland, and the 
sessions should last about twenty minutes each. The success with 
this means has been positive. 

3. To prevent accidents from sudden cessation of milk. These 
accidents have been greatly exaggerated by the older teachers of 
medicine, and these effete notions still prevail among the common 

(33 2 ) 



AGALACTIA AND OLIGOGALACTIA 533 

people. When they are believed to be present, the indications are 
to relieve the system by brisk watery purgatives, or to restore the 
secretion of milk by some of the means which have been above 
mentioned. 

C. H. F. ROUTH, M. D., LONDON. 

To induce a flow of milk in the breast, mechanical treatment 
may be applied to the breasts or to the genitalia — as witness, the 
effect of the application of the child, and this should be carefully 
persevered in. 

Electricity is a powerful stimulus, as Becquerel, Althaus, Skin- 
ner, and others, have proved in repeated cases, where they have 
succeeded in bringing on or restoring the secretion. Skinner's 
mode is : 

Direct. — both poles are'eovered with moist sponges ; the posi- 
tive is pressed deep into the axilla, and the negative applied to the 
nipple and areola ; the current being no stronger than is agree- 
able to the patient. Keep this position for about two minutes. 
Both poles are then to be inserted into the axilla, and graduallv 
brought together, the negative to the sternal, the positive to 
the opposite side of the organ. This may occupy about two 
minutes. 

Infra-mammary. — Imbed the poles in the mamma, move them 
about, raising and depressing both at once in and about the organ 
for another two minutes. Perform this daily. Generally one or 
two sittings suffice. 

As there exists great sympathy between the breast and the gen- 
ital organs, the proper functional use of the one will influence the 
other. 

Women who are nursing should have abundance of fresh air 
and cleanly surroundings, both of which are aids to lactation. 
As defective lactation is often induced by improper food, this, too, 
should be carefully observed, and supplied in sufficient quantities, 
and of proper quality — fish, rich in phosphorus, as oysters and 
crabs. In his own experience he giyes the preference to conger-eel 
soup. It is particularly nourishing, and readily improves the ap- 
petite and strength. Among vegetables, are the lentil powder, 
pea soup and bean soup, all of which improve the flow and richness 
of milk. Turnips and potatoes are generally,regarded as galacta- 
gogues. Edible fungi also increase the secretion. This author 



334 DISEASES OF MAMMARY GLANDS AND LACTATION. 

particularly lauds the Elaphomices granulatus or Boletus, or deer 
balls. 

Drinks are useful, but are apt to be abused, as ale or porter. 
Best of all is milk itself, which may be alternated with the malt 
liquors, say two or three tumblers of milk to one of stout, or they 
may be combined. 

Of medicines, he has found useful the Saponaria Vaccaria, cow 
basil, vaccaria in strong infusion ; the Sonchus Arvensis, corn sow- 
thistle, in decoction ; and the Ricimis communis. The latter, 
Routh was the first to use internally as a decoction in England. 
Every time the flow has been remarkably increased. Some ap- 
parent objections to its use are, a sensation of dimness of vision ; 
the dose requires to be increased, as it appears to lose its effect, a 
temporary suspension is best. Again, it seems to act as a diuretic. 
Here the breasts should be kept warm, and this result is less likely 
to occur. Where the diuretic effect is produced, it is well to smear 
the extract of the leaves over the breast in the same way as bella- 
donna is used, with a warm ordinary poultice outside. Dr. Routh 
uses a decoction of the leaves and stalks of the Ricinus. When 
an infusion of this article is given to non-suckling women, he has 
observed an internal pain in the breasts which lasts three or four 
days, and a copious leucorrheal discharge, after which the pain in 
the breast disappears. 

In two cases, he saw emmenagogue effects. In both, there ex- 
isted uterine congestion. This proves that the remedy should not 
be used in cases where there is disease or irritation of the womb. 
Its action is remarkable in that it is not restricted to any particular 
portion of the suckling period ; it may be immediate, that is, within 
twelve hours, rarely a week elapses before its galactagogue effect 
is observed; and lastly, its good effects do not wear off after a pro- 
tracted continuance of its use, but its omission will often lead to a 
diminution, if not cessation of the secretion. 

The Jatroplia Manihot, the tapioca or cassava plant, is said to act 
in a similar manner. 

The Coronilla Juncia, milk vetch, commonly called the milk 
weed, is second only to the castor oil-bean ; the fennel, dill, carrot, 
and several others, are popularly used, and no doubt more experi- 
ence would prove their value. 

Common salt may be regarded as a specific galactagogue. Cod- 



AGALACTIA AND OLIGOGALACTIA. 335 

liver oil undoubtedly would act efficiently, though it has not been 
sufficiently tested.* 

PROF. F. WINCKEL, M. D., ROSTOCK. 

Requires good nourishment, and tonics or stimulants. In some a 
tea of fennel and anise seed has acted well, or the milk powder of 
pulv. semin. fcenic, sugar, cort. aurant., aa 2 grains, magnes. carb., 
4 grains. 

Where on the contrary, the flow was too free as in galactorrhea, 
he would restrict the diet, promote copious alvine discharges, 
moderately compress the breasts, and nurse less frequently, and 
give iodine or iodide of potassium, 5 grains, three times a day. 

Kiwisch suggests the injection of a solution of caustic potassa, 
1-2 to 60 grains of water, into the excretory lacteal ducts. Hauck 
uses compresses wet with ^-decoction of oak bark, and afterwards a 
solution of nitrate of silver ; others quinine, ammoniated iron, 
alum, quassia,, and belladonna. 

Lange advises the lactate of iron with phosphate of lime. 

Joulin uses Agaricus albus y one gramme daily in four doses. 
Veit resorts to purgatives, diuretics, and diaphoretics, and daily 
friction of the skin with hand and brush. Abegg brings on in the 
course of 10 or 12 days, by means of the uterine douche, a mod- 
erate uterine hemorrhage, thus effecting a cure. 

E. CUTTER, M. D., BOSTON, MASS., 

In an article entitled, " Food as a Remedy for Agalaxia," says that 
he was led to the consideration of this subject by observing 
dairymen increase the quantity and quality of milk in cows by 
feeding them on bran, shorts, and meal. Hence, he was encour- 
aged to see if nursing women might not do as well if they sub- 
sisted on cereal food that had not been subjected to an abstraction 
of seventy-five per cent, of its mineral ingredients. He employed 
a diet, excluding flour, but including wheat and maize unbolted, 
but ground coarse or fine, and animal food, and ordinary vege- 
tables. In each case there was an abundant supply of excellent 
milk, and the child thrived accordingly. 

There are five grains, namely, wheat, rye, barley, oats, and maize, 
each and all sufficient for the purpose of supplying an aliment that 

*For a very interesting article on the subject of galactagogues we refer the 
reader to Routh's valuable work, "On Infant Feeding," to which we are in- 
debted for the foregoing. 



336 DISEASES OF MAMMARY GLANDS AND LACTATION. 

contains elements enough to sustain life in health, and enough, 
in the writer's opinion, to make milk. 

It is the excess of starch in flour, and the abstraction of three- 
quarters of 'its mineral elements, that, in the writer's judgment, 
cause the agalaxia generally observed. 

ROBERT P. HARRIS, M. D., PHILADELPHIA, 

In the American Journal of Obstetrics, Vol. II., p. 675, shows the 
value of milk as an article of diet for the nursing woman. It 
should be given in addition to the other diet, and partaken of 
in small quantities frequently repeated. Chocolate, cacao, and 
broma, made with a large proportion of milk, generally pure, is of 
great value, and should always be employed prior to the abandon- 
ment of the effort to nurse the child. 

PROF. WM. LEISHMAN, M. D., GLASGOW, 

Suggests artificial feeding of the infant for a time, and the applica- 
tion of warm fomentations to the breasts; the leaves of the castor- 
oil plant have also been extensively used as a local application. 
The leaves are boiled in water, and applied along with the water 
as a fomentation. 

RROF. FORDYCE BARKER, M. D., NEW YORK. 

Considers this as often the result of an improper diet of the lying- 
in woman. She is kept for a number of days on poor and insuffi- 
cient food, for fear of fever, etc.; and this, added to her exhaustion 
from labor, and a greater or less loss of blood during and after 
delivery, render her system incapable of performing the work as- 
signed it. 

RESUME OF REMEDIES. 

Fce7ricuhi7n in hot infusion, or a few drops of the oil, are popular remedies 

in deficient secretion. 
' Gallega. The goat's rue has a reputation in France. The Gallega Vir- 

gifiiana of this country has a similar repute in some parts of the 

United States (Stille). 
Ricinus. Castor-oil plant leaves are alleged to be very efficient (pp. 332 

"334). 
Faradisation is much praised by French writers. 

Fomentations, warm or hot, will frequently restore the secretion when 
temporarily checked. 



DISEASES OF THE NIPPLES. 

PROF. FORDYCE BARKER, M. D. NEW YORK, 

For sore nipples, recommends the following: 

298. R. Plumbi nitrat., gr.x-xx 

Glycerine, f.§j. M. 

He also directs, as soon as the child is taken from the breast, 
that the nipple be painted freely with compound tincture of ben- 
zoin. 

If the ulcerative process has commenced, stop nursing from that 
nipple and paint it with a solution of nitrate of silver, of the 
strength of gr. x. to f.oj. of distilled water. For inflammation of 
the nipple he recommends a soft bread and milk poultice for a few 
hours, and then keep the breast covered with one or two thick- 
nesses of linen wet with a solution of lead and opium. 

299. R. Aquas rosae, f^iijss 

Liq. plumbi subacet. dil., fjss 

Ext. opii aq„ 5j. M. 

Ft. lotio. 

After the inflammation is so far subdued that nursing can be 
borne without much pain, he applies the following after carefully 
washing the nipple : 

300. R. Aquas rosae, 

Glycerin., aa f.^ij 

Acidi tannici, 3ij- M. 

Ft. lotio. 

» 

(L Union Medicate du Canada, January, 1879.) The treatment 
recommended by M. Brochard for fissured nipples, is so simple 
that it deserves to be popularized. When chaps exist on the nip- 
ples, whatever their extent, the nipple should be washed with pure 
water, and then dried and dusted with siibcrin, which, as is known, 
is impalpable cork powder. The author has used it for several 
years, and prefers it to lycopodium for infants. 

Dr. Haussmann, of Berlin, recommends compresses soaked in a 
five per cent, lotion of carbolic acid, and changed every two or 
three hours, as the best remedy for sore nipples. If both breasts 
22 (337) 






338 DISEASES OF MAMMARY GLANDS AND LACTATION. 

are affected, and, nevertheless, suckling has to be carried on, the 
nipples must be carefully washed each time, before the infant is 
put to them, to prevent poisoning by the acid. 

The treatment pursued by Dr. Huebner, of Dresden, Saxony, 
in all lesions of the nipple and areola, consists in the constant ap- 
plication, day and night, of lukewarm compresses, wet with lead- 
water) fissures, ulcers, and excoriations being touched once or 
twice a day with balsam of Peru, and the breast well supported. 
The child should nurse less often than usual, and, where possible, 
through a nipple-shield. He recommends the warm lead-water in 
mastitis also, to be followed by strapping of the breast and free 
incision, while suppuration is promoted by poulticing. 

In chaps of the nipple, Dr. Charrier, of Paris, recommends the 
employment of perfectly pure picric acid in the following formulas: 
a. One and a half parts to 100 parts of distilled water; b. one part 
to the 100 parts. After thoroughly cleansing the nipple with 
tepid water, the solution a. is to be applied every morning with a 
pencil to the cracks; and immediately after suckling, the nipple is 
to be held for four minutes in a glass containing the solution b. 
The infants do not notice the bitterness of the medicine, and wil- 
lingly take the breast. 

Dr. Le Dieborder, of Paris, thinks that in obstinate fissure of 
the nipple, quinine will prove to be of the greatest service; and 
during a long experience of it, has always found that a cure was 
effected in from three to five days. He generally prescribed a dose 
of six grains early in the morning, and a similar dose about eleven 
o'clock, a. m. Local treatment was considered of secondary im- 
portance, being confined chiefly to poultices and some simple wash 
or salve. 

MR. ROBERT DRUITT, LONDON. 

301. I£. Acidi tannici, gr.iv 

Aquae destillatae, f-5 v j. M. 

This solution, as well as ointments and glycerites of tannin, is useful 
in cracked nipples. It should be applied on lint covered with oiled 
silk. 

DR. BLACQUIERES, FRANCE. 

302. I£. Extracti kramerias, gr.xv 

Olei amygdala? dulcis, f.5ss 

Butyri cocoas, 5ijss. M. 

To be applied to cracked nipples when the child has ceased to nurse ; 
to be removed before nursing. 



DISEASES OF THE NIPPLES. 




303. R. Zincl oxidi, 




Sodas boratis, aa 


gr.iss 


Olei amygdalae dulcis, 


f.oiss 


Butyri cocoas, 


9iv 


Olei bergamii, 


gtt.v. 


A useful liniment for cracked and chapped nipples 





339 



M. 



GERMAN HOSPITAL, PHILADELPHIA. 

304. R. Extracti opii, gr.iss 

Liquoris calcis, , f.3v 

Olei amygdalae dulcis, f-3iij- 

Dissolve the extract of opium in the lime-water and the oil, and shake 
vigorously. 

MR. ERASMUS WILSON, LONDON. 

The mucilage of acacia is a useful application to sore nipples. 
It should be penciled orb the part immediately after suckling, and 
the nipple then be protected by a leaden shield. Or the following 
powder may be applied : 



3°5- $■ 



Acaciae gummi pulveris, 
Sodas biboratis, 



aa ^ss. 



M. 



SAMUEL SLOAN, M. D., GLASGOW, 

(Obstet. Jour. Grt. Brit., Jan., 1878), gives this plan: Carefully- 
wash off the nipple with tepid water after each nursing; then wash 
it with weak spirit lotion, and glycerine, to prevent drying ; or, if 
the excoriation be advanced, add an astringent, as tannin or a weak 
solution of nitrate of silver. If the part be not inflamed, to protect 
the nipple use a shield and apply a mild ointment, as oxide of zinc. 
If the nipple be retracted, gently draw it out with a breast pump. 
If still painful, use a glass nipple with a rubber teat. This ought 
to be of a proper shape; if too narrow, it constricts the nipple 
and occludes the ducts ; if too long, a vacuum is caused between 
the extremity of the nipple and the mouth of the child, so that it 
can not draw the milk into the teat. If too long, it will also tickle 
the fauces of the child. 

Before applying the child to this nipple, the latter ought to be 
filled with some of the mother's milk ; or, if this is not practicable, 
with sweetened milk and water. Some children take so kindly to 
this artificial nipple that it is difficult, after being long accustomed 
to it, to persuade them to use their mother's nipple again. But, 
should only one nipple be affected, this will not readily happen, 
especially if the artificial teat be small enough. The shield and 






34-0 DISEASES OF MAMMARY GLANDS AND LACTATION. 

teat in one piece, made of India rubber or other soft material, as 
softened ivory, will make suction easier for a weakly child, if it 
can be borne by the mother. There is, however, with its use, con- 
siderable compression of the nipple by the child's gums. A good 
artificial nipple has yet to be devised. If the nipple-shield can 
be borne, and the child can be coaxed to use it, there will be little 
difficulty in curing the nipples on general principles. In the event 
of excoriation of the nipple continuing after this attempt with the 
artificial nipple, and ulceration setting in, there remains no course 
but to take the child at once from that breast till the part is suffi- 
ciently restored to permit of its reapplication. And here the care- 
ful use of a good breast-exhauster is important. For, should the 
breast become engorged while the nipple is tender, there is every 
prospect of abscess of the breast taking place. No matter how 
tender the nipple may be, a careful regulation of the compression 
ball by the hand, with occasional relaxation of the nipple to pre- 
vent occlusion of the lactiferous tubes, will always result in the 
almost painless removal of the milk; though, should the breast be 
hard and yet no milk come, gentle friction at the periphery of the 
breast may be required to expel the milk from the gland proper 
into the lactiferous reservoirs under the areola, whence the breast- 
exhauster will readily withdraw it. It will now be a comparatively 
easy matter to heal the nipple, since the first step in treating a 
disease is to remove the cause ; the impracticability of doing this 
rendering the treatment of the nipple so unsatisfactory. If there 
be ulceration, careful washing and drying of the nipple, and the 
application of the solid nitrate of silver to the part affected only, will 
generally suffice. This treatment by a "tough caustic point" is, 
when combined with the use of the nipple-shield, a certain cure of 
the fissures which occur around the base of the nipple. If the 
part be inflamed, sedative applications or poultices will of course 
be the first indication. Should the affection of the nipple arise 
from an aphthous condition of the child's mouth, the application of 
borax and glycerine, or chlorate of potassa dissolved in glycerine, 
is the proper treatment for the nipple as for the mouth. Perhaps 
it may suffice to point out, regarding some recent investigations 
which have been made as to the quality of the milk as a factor in 
the production of sore nipples, that, where one nipple only is af- 
fected, this condition of the milk can have only a very limited ef- 
fect as an exciting cause. 



DISEASES OF THE NIPPLES. 341 

It is pleasing to pass from the too often disappointing treatment 
of tender nipples to consider the possibility of having the nipples 
perform their natural functions without the usual morbid results. 

It has been customary to order, as a prophylactic, weak spirit 
and water, or other mild astringent, but no evil results from the 
application of stronger astringents. As an astringent, however, 
especially if strong, is likely to cause a hardening only, and not a 
toughening of the nipple, we may have this organ cracking as 
soon as the outer film of hardened cuticle is removed, on the first 
application of the child to the breast. To obviate this, mix glycer- 
ine with the astringent, and some fatty substance, as lard. The 
selection of the particular astringent is, of course, of importance ; 
but the thoroughness with which it is applied is more so. The 
solution preferable is made thus : A large teaspoonful of dry tea 
is put into a two-ounce vial, one ounce of brandy and a quarter of 
an ounce of glycerine are added, and, after a few days, with occa- 
sional shaking, the solution is ready for use. For two or three 
months previous to parturition, the nipples should be thoroughly 
washed every night with cold water and glycerine soap, dried, and 
the above solution carefully brushed over the nipple, but especially 
around the base and into the apex. This is left on all night, and, 
in the morning, the lard is rubbed well in. 

During this treatment the dress ought to be loose ; and, if the 
nipples are at all retracted, they ought to be drawn out occasion- 
ally by suction or with the fingers and thumb. A circular piece 
of some unirritating material, with a hole in the centre, might be 
used in severe cases. 

When the child is born, examine the nipples and breasts. If 
the latter are flaccid, do not put the child early to the nipple ; and, 
when the milk has appeared, advise the application of the child at 
intervals of not less than two hours, and to both nipples at each 
application, giving careful instructions against letting the nipple 
remain in the child's mouth after it has emptied the breast, and 
especially against allowing it to sleep at the breast. The nipple is 
to be moistened with water or saliva before applying the child to 
it; and, when the infant quits the breast, the nipple should be 
washed with a mild astringent and antiseptic solution with gly- 
cerine ; as a teaspoonful each of whisky, tincture of arnica, and 
glycerine in a wineglassful of cold water. The nipple, as soon as 
the infant leaves the breast, is washed with this and partially dried, 



342 DISEASES OF MAMMARY GLANDS AND LACTATION. 

and a nipple-shield at once applied to protect the nipple from fric- 
tion against the dress. 

C. H. F. ROUTH, M. D., LONDON. 

Of soothing applications, in mild cases, gum, honey, solution of 
tolu, or Friar's balsam, may be applied with a camel's hair brush 
after each act of suckling. Often, melted mutton fat, put on warm 
and allowed to cool, will heal such sores when everything else 
fails. Fuller's earth or bismuth are useful, but the civeolia levigata 
is a powder superior to any other. It is eminently soft, and will 
sometimes cure the most obstinate sores. 

Caustics are efficacious if employed skilfully. A solution of 5- 
10 grains nitrate of silver, in an ounce of water, or 10 grains of 
chlorate of potassa, or bicarbonate of soda, will prove very healing. 

Shields aid greatly by protecting the part. The caoutchouc nip- 
ple is preferred. Stretched on a glass or wooden base, they are 
better. Or the nipple may be wholly of glass or wood. It should 
fit the mother's nipple exactly, and not be too deep. 

However, prevention is better. For two months or so before 
delivery, the nipple should be carefully sponged night and morn- 
ing with some astringent lotion, as oak bark, or cologne water, to 
overcome the delicacy of the skin, and the nipple brought out by 
the use of the shield. 

E. W. SAWYER, M. D., CHICAGO. 

This writer, in the Chicago Med. Jour, and Exam., Dec. 1877, 
advises to remove the organ from the irritation by the use of a 
shield. They are all made to cover the nipple, as a thimble, and 
rest air-tight upon the breast, and are surmounted with a false nip- 
ple of caoutchouc. If aspiration is applied to the rubber nipple, 
an incomplete vacuum is formed in the shield, which is filled by 
the milk from the ducts. The most efficient, at the same time the 
cheapest and most simple variety of nipple shields, is a plain bell- 
glass, with a broad base to rest upon the breast. If the bearing 
surface of the shield is wetted with saliva or glycerine, it will fit 
upon the breast more tightly. 

It is true that the use of this kind of cupping glass is not al- 
ways free, from pain, because it induces an engorgement of the nip- 
ple ; but there is no other way in which the nipple can be placed 
so nearly at rest, at the same time that lactation is kept up. The 
immediate relief and rapid improvement which have followed the 



DISEASES OF THE NIPPLES. 343 

temporary use of this means, in cases where all sorts of lotions 
and collodion coating had failed, is surprising. 

It sometimes happens that the child is not vigorous enough to 
draw the milk through the shield; then the aspiration should be 
made by an adult. In this manner the breast can be sufficiently 
emptied to protect it from trouble, until the lesion of the nipple has 
recovered. In the mean time the child can be sustained from the 
sound breast. Sometimes both nipples are the seat of lesions at 
the same time. Under these circumstances, if the child is unable 
to draw the milk through the shield, some other means must be 
devised, so that the milk may be saved for the infant. Make use of 
that simple form of breast- pump, which is practically like the nip- 
ple-shield. The bell-glass has a diverticulum, in which the milk is 
collected ; and in place of the false nipple, there is a large rubber 
bulb, by means of which the vacuum is made. The milk can be 
poured from the receptacle, as often as filled, kept warm, and fed 
to the child with the spoon, or the simple nursing bottle. 

To cure the ulcers and fissures after the part is thus placed at 
rest, the benzoated zinc ointment is best. Wash the part carefully 
with castile soap and water, and cover the entire nipple and areola 
with the ointment. This need not be removed before drawing the 
milk through the shield. A few drops of carbolic acid will in- 
crease the efficiency of the ointment. For very red and highly 
inflamed nipple, the best is a lotion of acetate of lead. This must 
always be washed off before the the milk is drawn. If the ulcers 
are indolent, touch them with nitrate of silver. Ordinarily the 
ulcer needs only to be kept clean. 

If the fissures are deep, glue the wound by coating it with col- 
lodion. 

PROF. W. S. PLAYFA1R, M. D., LONDON. 

Prepare the nipple during the latter months of pregnancy, by 
daily bathing it with a spirituous or astringent lotion, as cologne 
and water, or a weak solution of tannin. Wash and dry the nip- 
ples after each act of nursing, and if tender, protect it with a shield. 
Dr. Wilson, of Glasgow, in fissures of the nipple, uses a lotion of 
ten grains nitrate of lead in an ounce of glycerine, applied after 
each time of nursing, and the nipple carefully washed before the 
child is allowed to nurse. 

This author finds nothing so good as a lotion of one-half an 



344 DISEASES OF MAMMARY GLANDS AND LACTATION. 

ounce each of sulphuric acid and glycerine of tannin, and an ounce 
of water, the beneficial effects of which are sometimes remarkable. 

PROF. WM. LEISHMAN, M. D., GLASGOW. 

Uses in obstinate cases, 

306. I£. Ac. tannici, gr.iij 

Glycerini, f-5ss 

Ung. cetacei, §j. M. 

In fissures, introduce this by means of lint. If the margin be 
callous, apply solid nitrate of silver. 

PROF. FLEETWOOD CHURCHILL, M. D., DUBLIN. 

Prefers nitrate of silver in weak solution applied after each suck- 
ling. Mr. Druitt recommends five grains pure tannin in an ounce 
of distilled water. Dr. Johnson applies alternately: 

307. ]£. Sodae boracis, 5ij 

Cretae praep., 5j 

Spt. vini, 

Aq. rosae, aa f.gilj, ft. lotio. 

308. ty.. Ceras albas, ' ^ivss 

01. amygdal. dulc, f.Sjj 

Mel. despumat., f.§ss. 
Dissolve by heat, then add by degrees, 

Bals. Peruvian, f.5ijss. ft. unguent. 

Drs. McClintock and Hardy use tincture of catechu. 
M. Bourdell applies lint soaked in tincture of benzion, repeated 
so as to form a coating over the sore. 

SAMUEL SLOAN, M. D., GLASGOW, 

(Obst. Jour., G. B. and I., Jan., 1878,) employs prophylaxis 
against sore nipples. He puts a large teaspoonful of dry tea into 
one ounce of brandy and a quarter of an ounce of glycerine. 
With occasional shaking, after a few days it is ready. For two or 
three months prior to delivery, the nipples are to be washed 
nightly with cold water and glycerine soap, dried, and the above 
solution brushed over the nipple and its base. In the morning, 
lard is well rubbed in. The dress must be loose, and retracted nip- 
ples drawn out. After delivery, moisten the nipple at each nurs- 
ing, and after it wash with whisky, tincture of arnica and glycer- 
ine, each a teaspoonful in a wineglassful of cold water. The nip- 
ple shield must be used to prevent irritation by the dress. When 
suckling deprives the nipple of its natural oil, apply fresh oxide of 
zinc ointment. 



DISEASES OF THE NIPPLES. 345 

PROF. F. WINCKEL, M. D., ROSTOCK, 

In simple erythema and phlegmon, compresses wet with lead 
water may be applied, taking care to cleanse the nipples before 
nursing. If there are slight erosions or excoriations, use a solu- 
tion of nitrate of silver, one part to thirty; or alum, sulphatr of 
zinc, etc., or sannin, one to fifty. Ulcers may be covered with bal- 
sam of Peru or copaiva, always using a shield to prevent a contin- 
uance of the irritation. When the raw spots remain, or the ulcers 
increase, the patient has fever, etc., wean the child. Velpeau uses 
lotions of lead water, or of oil and red wine, oil and lime water 
equal parts, nitrate of silver or sulphate of zinc, one or two parts 
to six of water. Cracks he sprinkles with the seeds of earth moss. 
Inflammation he treats wi|:h local discutients, mercurial salves, and 
poultices. 

Legroux paints the parts with: 

309. $. Collodion, 30 p 

Castor oil, . y 2 p 

Oil of turpentine, \ l / 2 p. 

and then covers them with gold beater's skin perforated with pin 
holes over the apex of the nipple. Soften this covering with sugar 
and water before the child nurses. 

Bourdel and Anselmier use the powder and tincture of ben- 
zoin. 

Elsasser uses oil of cloves with lime water in inflammation, and 
in painful bleeding excoriations, applies unguent, rosae, with lauda- 
num and oxide of zinc. Ulcers he covers with balsam of Peru. 

RESUME OF REMEDIES. 

Acacia is extolled by Wilson and others, as an excellent application (F. 

3°5)- 

Argenti Nitras is a useful application. The caustic pencil may be ap- 
plied to the fissures or ulcers, or the part may be enveloped in 
lint wet with a weak solution. It is especially called for when 
the fissure is at the base of the nipple and veiy painful. After 
the caustic, compound tincture of benzoin should be applied. 

Balsamum Peruvianum is valuable for local use. Phillips recommends : 

310. ]£. Balsami peruviani, f.5ij 

Olei amygdal. aula, f.3iss 

Acaciae, 3M 

Aquas rosae, , f.^j. M. 

Apply five or six times a clay. 



346 



DISEASES OF MAMMARY GLANDS AND LACTATION. 



Benzoini Tinctara Comp., may be used with most satisfactory results in 
most cases. Wipe the nipple dry after the child has nursed, and 
with a brush apply four or five coats of the tincture. It may at 
first produce some burning, but cicatrization will soon take place 
under this coating. It does not interfere in the least with 
lactation. 

Bismuthi Subnitras. As a neutral protective and absorbent powder, none 
can be found superior to this. 

Calcis Liquor is a soothing application in light cases. 

Carbolicum Acidum has been much praised by Dr. Haussman, of Berlin, 
(P- 331)- I ts advantage is, he claims its capability not only of 
reaching and superficially cauterizing the open mouths of the 
finest lymphatic vessels laid bare in the wound, but also of pen- 
etrating completely into them, so as to destroy any parasitic 
germs or infectious organic bodies of any kind which may be 
brought to the nipple by the child's mouth, the hands of the 
mother, doctor, or nurse, or in any other way, and so prevent 
the developement of the various forms of inflammation in the 
breast itself. The application of carbolic acid is not nearly so 
painful as that of nitrate of silver, and a cure is obtained more 
quickly with the former than the latter drug. A strong (5 per 
cent.) solution seems to be decidedly more efficacious than a 
weaker (2 per cent.) solution. 

Collodion is a protective agent often of service. Dr. Albert II. Smith, 
of Philadelphia, employs 

311. I£. Emplastri plumbi, 5ij 

yEtheris sulphurici, f.5ss 

Collodion flexile, f.|j. M. 

Powder the lead-plaster, add the ether, and mix them well to- 
gether before adding the collodion. It makes a creamy mix- 
ture, and is to be applied with a brush over every portion of 
the carefully dried nipple, with the exception of the opening 
of the milk ducts. 

Galla has been found useful by Dr. Q. C. Smith. 

312. ^. Pulv. gallae, §j 

Olei menthae piper., gtt.x 

Tinct. opii camphor., q. s. M. 

Make a thick paste and apply just after the child nurses. It 

should be removed by gentle washing before the infant 

nurses a?ain. 



Glycerina is much employed as an excipient. The glyceroles of lead, 
tannin, etc., are frequently efficient. 

Hydrargyri Chloridum Mite. When the ulceration has destroyed the 
surface of the nipple, Dr. Barker recommends that the child be 
prevented from nursing, and the following applied : 



DISEASES OF THE NIPPLES. 347 

313. f£. Hydrargyri chloridi mitis, gr.xxx 

Magnesiae, gr.xx 

Unguenti rosae, §j. M. 

Rub together very carefully and prepare fresh daily. 

Iodoformum. Dr. M. O'Hara, of Philadelphia, uses : 

314. I£. Iodoformi, 5ss 

Collodion, f.§j. M. 

Kr anuria is popular with some. (¥. 302.) 

Picricum Acidum has been extolled by D^Charrier. (Page 338.) 

Pix Liquida is a valuable local application in eczematous conditions of the 
nipple. 

Plumbi Nitras is, according to Dr. Barker, the most complete prophy- 
lactic against the occurrence of sore nipple that we have. He 
directs, as soon as there is any inflammation of the nipple, to 
apply a poultice until the immediate symptoms are subdued, and 
then apply a solution of nitrate of lead gr. x, to glycerine f.§j. 
It should be used immediately after nursing, having washed the 
nipple perfectly clean. The nitrate is said to be of little use 
after fissures have actually occurred. 

Plumbi Subacetatis Liquor is a grateful cooling lotion, properly diluted. 

Salicylicum Acidum has been tried with excellent results in cracked and 
lacerated nipples. It is important not to apply it too strong, or 
it will irritate. Numerous and careful trials in the Vienna Hos- 
pitals have decided that the strength must not be over four per 
cent., as: 

315. I£. Acidi salicylici, gr.xv-xx 

Alcoholis, q. s. to dissolve 

Unguenti petrolei, §j. M. 

Apply on lint, or rub in several times a day. 

Sodii Biboras in solution and ointment has a long-standing reputation. 
Suberin has been recommended (p. 337). 

Tannicwn Acidum is an excellent astringent. Dr. S. S. Purple, of New 
York {Medical Record, 1879), employs: 

316. fy. Acidi tannici, 3j 

Acacias mucilaginis, f-Siij 

Aquas, f.fij. M. 

It can be applied to the nipple and breast with the finger, and 
should remain exposed to the air until perfectly dry. The 
glass can then be worn over the nipple to protect it from the 
clothing, and he usually had no trouble in the management 
of the case. 

Zinci Oxidum is a soothing application in the form of the benzoated 
ointment. 



INDICES. 



INDEX OF DISEASES. 



Abscess of breast, 309. 
Abortion, 200. 

habitual, 203. 
induction of, 206. 
threatened, 209. 
Absorptive power of vagina, 161. 
Adenitis of breast, 321. 
Adenoma of breast, 324. 
After-pains, diagnosis of, 306. 
treatment of, 248. 
Agalactia, 332, 335. 
Albuminuria, 264, 271. 

of pregnancy, 228. 
Amenorrhea, diagnosis of, 21. 
treatment of, 33. 
phthisis in, 22. 
Anaphrodisia, 152. 
Anaesthetics in labor, 233. 

when indicated, 235. 
caution in use of, 237. 
in turning, 237. 
Anemia, diagnosis of, 24. 
treatment of, 80. 
Antiseptic midwifery, 281. 

• surgery, 311. 
Ascites, 19. 

Atony of uterus in labor, 239. 
vaginal walls, 167. 

Backache, 93. 

Benign growths in breast, 322. 

Bladder, diseases of, 157. 

irritable, 158, 192. 
tenesmus of, 159. 
Blood poisoning, 231. 
Breast, abscess of, 309. 

diseases of the, 309. 

adenoma, 324. 

benign growths in, 322. 

carcinoma of, 224. 

clear fluid in, 322. 

dark fluid in, 322. 

encephaloid of, 322. 

fibroid tumors of, 324. 

fluids in, 322. 

hydatid tumors of, 324, 



Breast, hysterical, 322. 

neuralgia of, 326. 
pus in the, 322. 
sarcoma of, 321. 
scirrhus of, 321. 
suppuration of, 312. 
tumors of, 321. 

Carbonate of ammonia in the blood in 

pregnancy. 231. 
Carcinoma of breast, 324. 
of uterus, 148. 
Catarrhal urethritis, 190. 
Catarrh, uterine, 93. 

Caution in use of anesthetics in labor, 237. 
Cell, ovarian granular, 20. 
Cellulitis, pelvic, 292. 
Cerebral disturbance of pregnancy, 230. 
Cervicitis, 88, 105. 

gonorrheal, 174. 
Change of life, 24, 81. 
Chapped nipples, 338, 339, 345. 
Chlorosis, diagnosis of, 24. 
dyspepsia of, 78. 
treatment of, 77. 
Clear fluid in breast, 322. 
Climacteric, 24, 81. 
Clothing during pregnancy, 198. 
Colloid cysts, 19. 
Complications of parturition, 233. 
Congestion of kidney in pregnancy, 229. 
Congestive dysmenorrhea, 46. 
Constipation of pregnancy, 214, 226, 230, 

231. 
Contraction of vagina, 176. 
Convalescence, puerperal, 306. 
Cord, hemorrhage from the, 284. 
Cosmetics, poisoning from, 166. 
Cox-comb granulations, 144. 
Clacked nipples, 338, 339, 345. 
Cystitis, 158, 187. 
Cysts, colloid, 19. 
dermoid, 19. 
of Fallopian tube, 19. 
of the ovary, 19, 31. 
parovarian, 19. 



(349) 



350 



INDEX OF DISEASES. 



Cysts, sub-peritoneal serous, 19. 

Dark fluid in the breast, 322. 

Dermoid cysts, 19. 

Despondency in pregnancy, 222. 

Diabetic pruritus, 182. 

Diarrhea in pregnancy, 226. 

Digestive derangements of pregnancy, 225 

Disorders of parturition, 233. 

Displacements of uterus, 122. 

Dropsy, ovarian, 31. 

Dysmenorrhea, 22, 46. 

congestive, 46. 

spasmodic, 49, 55, 57. 

from general causes, 49. 

through inefficiency, 50. 

menorrhagic, 50. 

irregular, 50. 

rheumatic, 52, 56. 

membranous, 54, 57. 

neuralgic, 46, 55, 57. 

ovarian atonic, 47, 56, 57, 
Dyspareunia, 176. 
Dyspepsia of chlorosis, 78. 
ovarian, 28. 
of pregnancy, 225. 
Dysuria, 159,192. 

Eclampsia, puerperal, 229, 231, 264, 267. 

reflex, 266. 
Eczema genitale, 182, 183. 
with diabetes, 182. 
Edema in pregnancy, 228. 
Embolism, 289. 

Encephaloid cancer of breast, 322. 
Endo-cervicitis, 87, 89. 
Endometritis, 87, 89, 92,95, 183. 
Enuresis, 159. 

Erythema of the nipple, 345. 
Excessive distension of uterus, 242. 
Excoriations in vagina, 176. 
Excrescences in vagina, 179. 
Exercise during pregnancy, 198. 

Fallopian tubes, cysts of, 19. 

Fatty degeneration of chorion villi, 200. 

Feeble action of uterus in labor, 239, 242. 

Fetid vaginal discharge, 170. 

Fever, milk, 304. 

puerperal, 276, 282. 
Fibroid tumors of breast, 324. 
Fibrous tumors of uterus, 139, 142. 
Fissures of nipple, 337, 338, 344. 
Flexures, uterine, 129. 
Fluids, in the breast, 322, 324. 
Fluids ovarian, 20. 
Food during pregnancy, 198. 
Forceps, the, in labor, 234, 237, 239, 242, 
243, 265, 291. 

Galactocele, 322. 

Galactagogues, 332, 333, 334, 335, 336. 



Galactorrhea, 327. 

Gangrene of a limb, 289. 

Genitals, pruritus of, 181. 

Gingivitis, 225. 

Glands, mammary, congestion of, 316. 

Gonorrheal acute ovaritis, 174. 

cervicitis, 174. 

metritis, 174. 

urethritis, 174. 

vaginitis, 157, 172. 
Green sickness, 77. 
Growths, malignant, 148. 

non malignant, 137. 
papillomatous, of vulva, 179. 

Habitual abortion, 203. 
Headache of pregnancy, 221. 
Heart palpitation in pregnancy, 221. 
Hemorrhage, accidental,during pregnancy, 

205, 254. 
Hemorrhage, from the cord, 254. 

passive, 59, 64. 

post-partum, 234, 250, 260. 

post-partum, secondary, 252. 

puerperal, 250. 

uterine, 23. 
Hemorrhoids, 226. 
Hydatid tumors of the breast, 324. 
Hydremia of pregnancy, 231. 
Hygiene of the puerperal state, 197. 
Hyperemia of the kidneys, 229. 

ovaries, 27. 
Hypochondriasis of pregnancy, 222. 
Hysteria, 71. 
Hysterical breast, 322. 

Impoverished blood in pregnancy, 228, 

230. 
Incontinence of urine, 194. 
Induction of premature labor, 206. 
Inertia uteri in labor, 242. 
Insomnia of pregnancy, 222. 
Instrumental delivery, see Forceps. 

anesthesia for, 237. 
Inversion of uterus, 130. 
Irregular action in labor, 242, 251. 
Ischuria, 159. 

Kidney, congested, in pregnancy, 229. 
hyperemia of, 231. 

Labor, anaesthetics in, 233. 

antiseptic management of, 280, 281 . 

atony of uterus in, 239. 

complications of, 233. 

disorders of, 233. 

to facilitate, 240. 

to shorten, 240. 

induction of premature, 206. 

irregular action in, 242, 251. 

lacerations of perineum in, 233. 

premature, 200. 



XDEX OF DISEASES. 



351 



Labor, occluded os uteri in, 242. 

rigid os in, 239, 242. 

rigid perineum in, 233. 

tedious, 233, 239. 
Lacerations of perineum, prevention of, 

2 33- 
Laceration of vagina or vulva, in labor, 

255- 
Lactation, to establish, 332, 333. 
Lead-poisoning from cosmetics, 166. 
Leucorrhea in pregnancy, 164, 167, 168, 

169, 223. 
Life, change of, 24, 81. 
Lochial discharge, excessive and septic, 

276. 
Lymphangitis, mammary, 319. 

Mammary abscess, 309. 
adenitis, 310. 
adenoma, 321. 

glands, acute congestion of, 316. 
hypertrophy, 323. 
lymphangitis, 319. 
neuralgia, 326. 
sarcoma, 321. 
scirrhus, 321. 
tumors, diagnosis of, 321. 
treatment of, 322. • 
Mammitis, acute, 313. 

chronic, 314. 
Mania, puerperal, 271. 
Marital relations during prepnancy, 199. 
Mastitis, 309. 
Mastodynia,326. 
Melancholia of pregnancy, 222. 
Membranous dysmenorrhea, 54, 57. 
Menopause, 24, 81. 
Menorrhagia, diagnosis of, 23. 

treatment of, 59, 82, 240. 
Mental condition during pregnancy, 199. 
Menstruation, too frequent, 65. 
Metritis, 88, 90, 96. 

gonorrheal, 174. 
puerperal, 295. 
Metrorrhagia, diagnosis of, 23. 

treatment of, 59. 
Milk fever, 304. 
Milk, to increase the flow of, 332. 

decrease the flow of, 327, 328. 

329.330,33I- 

Milk tumors, 323. 

Milky fluid in the breast, 322. 

Mucous polypi, 138. 

"Nagging pains," anesthesia for, 237. 
Nausea of pregnancy, 214. 
Nervous cough in pregnancy, 222. 
Neuralgia in pregnancy, 221. 

of the uterine neck, 49. 

of breast, 326. 

of ovaries, 27. 
Neuralgic dysmenorrhea, 46, 55, 57. 



Nipples, diseases of, 337. 

cracked, 338, 339, 345. 

erythema ol, 345. 

fissures of, 337, 338, 344. 

phlegmon of, 345. 

sore, 337, 339. 
Nymphomania, 155. 

Obstetrical therapeutics, 195. 

Obstructions, pulmonary, 289. 

Occluded os in labor, 242. 

Oedema of the vulva, 158. 

Oligogalactia, 332. 

Ovarian cysts, 19, 31. 

Ovarian dropsy, 31. 

Ovarian dyspepsia, 28. 

Ovarian dysmenorrhea, 47, 56, 57. 

fluids, 20. 

granular cell, 20. 

hyperemia, 29. 

neuralgia, 27. 

tumors, 18. 

diagnosis, 19, 31. 
Ovaries, diseases of, 17. 
Ovaritis, 17. 

chronic, 17. 

acute, 17. 

treatment of, 26. 
Oxytocics, 242, 244. 

Pain in right side in pregnancy, 222. 

vagina, 177. 
Pains, after, 248. 

Palpitation of heart in pregnancy, 221. 
Papillomatous growths of vulva, 179. 
Parovarian cysts, 19. 
Parturition, complications of, 233. 
Passive hemorrhage, 59, 64. 
Pelvic cellulitis, 292. 

peritonitis, 292. 
Perimetritis, 96. 
Perineum, lacerations of, in labor, 233. 

rigidity of, in labor, 233. 
Peritonitis, diagnosis of, 292, 306. 
pelvic, 292. 
puerperal, 292, 297. 
Phlegmasia dolens, 302. 
Phlegmon of nipple, 345. 
Phosphatic diathesis in pregnancy, 229. 
Phthisis, amenorrhea in, 22. 
Placenta prsevia, 250, 253, 254, 255, 256. 

retention of, 254, 255. 
Poisoning from cosmetics, 166. 
Polypi, 23, 137, 138. 

uterine, complicating labor, 255. 
Polyuria, 159. 
Post-partum hemorrhage, 240, 250, 260. 

from anesthetics, 

. 2 34- . 
Pregnancy, congestion of kidney in, 229. 

constipation of, 214,226, 230, 
231. 






352 



INDEX OF DISEASES. 



Pregnancy, disorders of, 197. 

albuminuria in, 228. 
antiseptics during, 281. 
ammonia in blood during, 231. 
cerebral disturbance in, 230. 
clothing during, 198. 
diarrhea of, 226. 
exercise during, 198. 
food during, 198. 
headache of, 221. 
hemorrhage during, 205, 254. 
hydremia of, 231. 
hypochondriasis during, 222. 
impoverishedbloodin,228,230. 
indigestion of, 225. 
insomnia of, 222. 
leucorrhea in, 164. 

167, 168, 169, 223. 
marital relations during, 199. 
melancholia in, 222. 
mental condition during, 199. 
nausea of, 214. 
nervous cough in, 222. 
neuralgia in, 221. 
oedema in, 228. 
pain in right side in, 222. 
palpitation of heart in, 221. 
phosphatic diathesis in, 229. 
pruritus of, 223. 
salivation of, 225. 
sleep during, 198. 
syncope in, 224. 
Premature labor, 200. 
Procidentia uteri, 129. 
Prophylaxis of puerperal eclampsia, 229. 

sore nipples, 344. 
Prolapsus uteri, 132. 
Pruritus of diabetic, 182. 
pregnancy, 223. 
pudendalis, 182. 
vulvae, seu vaginae, 181. 
Puerperal convalescence, 306. 

eclampsia, 229, 231, 264, 267. 
fever, 276, 282. 
mania, 271. 
metritis, 295, 299. 
peritonitis, 292, 297. 
pyemia, 276. 
septicemia, 276. 
shock, 291. 
state, hygiene of, 197. 
thrombus and embolism, 289. 
salivation, 2 '5. 
women, laxatives for, 307. 
Pulmonary obstructions in labor, 289. 
Pus in the breast, 322. 
Pyrexia, 276. 

Rectum, disease of, 178. 
Reflex eclampsia, 266. 
Relaxation of uterus, 254. 
Renal congestion, 228. 



Retarded involution of the womb, 307. 
Retention of placenta, 254, 255. 
Rigid os uteri in labor, 239, 242, 
Rigidity of perineum in labor, 233. 

Salivation, puerperal, 225. 

Sarcoma of breast, 321. 

Scirrhus of breast, 321. 

Septicemia, 201, 276, 279, 280, 281, 282, 

286. 
Sero-purulent discharge from vagina, 169. 
Serous cysts of breast, 323. 
Shock, puerperal, 291. 
Sleep during pregnancy, 198. 

want of, during pregnancy, 222. 
Sore nipples, 337, 339. 
Sterility, 152. 
Subinvolution, 23. 
Suppuration of breast, 312. 
Sympathetic nervous disorders, 221. 
Syncope in pregnancy, 224. 
Syphilitic infection, 200, 204. 

Tedious labor, 233, 239. 

Tenesmus uteri, 49. 

Threatened abortion, 203. 

Thrombus, 289. 

Toxic eclampsia, 266. 

Tumors of breast, 321, 322, 324. 

uterus, 137, 139, 142, 148. 

milk, 323. 

ovaries, 18, 19, 31. 
Turning, anaesthesia for, 237. 
Tympanites, 279. 

Ulceration of the nipple, 337, 338, 344, 

345- 
Ulcer, indolent, 105. 
inflamed, 105. 
fungous, 105, 106. 
senile, 105. 
diphtheritic, 105. 
Ulcerations, bleeding, 106, 145. 
Uremia in pregnancy, 231. 
Urethra, caruncle of, 179, 
diseases of, 157. 
Urethritis, 190. 

gonorrheal, 174. 
Uiinary disorders, 158, 192. 
Urine, incontinence of, 194. 
Uteri, carcinoma, 148. 
procidentia, 129. 
prolapsus, 132. 
tenesmus, 49. 
Uterine atony in labor, 239, 242. 
catarrh, 168. 
changes, 86. 
displacements, 122, 130. 
flexures, 129. 

inertia in labor, 234, 239, 242. 
inflammations, 87. 
involution retarded, 307. 



INDEX OF REMEDIES. 



353 



Uterine, polyp, hemorrhage during labor 
lit in. 255. 
relaxation, 254. 

by chloroform, 234. 
symptoms, 86. 
tenesmus, 49. 
tumors, 139, 142. 
Uterus and its annexes, diseases of, 85. 

excessive distension of in labor, 

242. 
neuralgia of neck of, 49. 
occlusion of os, in labor, 242. 

Vagina, absorptive power of, 161. 

contraction of, 176. 

diseases of, 157. 

excoriations in, 176. 

excrescences in, 179. 

hyperesthesia of, 178. 

pain in, 177. 

sero-purulent discharge, from, 
169. 
Vagina or vulva, laceration of in labor, 

255- 
varicose veins in, 250, 

255- 



Vagina or vulva, vegetations in, 179. 
Vaginal discharges, fetid, 170. 
growths, 179. 
injections, 160. 
irrigations, 160. 
thrombus, 289. 
walls, atony of, 167. 
Vaginismus, 176. 
Vaginitis, 157, 160. 

gonorrheal, 157, 172. 
specific, 157, 172. 
from lead poisoning by cosmet- 
ics, 167. 
Varicose veins in vagina, 250, 255. 
Vegetations in vagina, 179. 
Vesical irritability, 159. 
irritation, 192. 
tenesmus, 159. 
Vomiting of pregnancy, 214. 
Vulva, oedema of, 158. 

papillomatous growths of, 179. 
pruritus of, 1 81. 
Vulvitis, 181. 

Warts in vagina, 179. 
Womb, see Uterus. 



INDEX OF REMEDIES. 



Abdominal frictions for inertia uteri, 239, 

246. 
Abortifacients, 212. 

Abscess of mamma, to prevent, 309, 3 10,3 1 1. 
Abstention from fluids to cure mammitis, 

3H- 
Acacia, 339, 345, 347. 
Acetum, 144, 261, 287, 318. 
Achillea millefolium, 41, 65. 
Acid, with opium, 248. 
Acid nitrate of mercury. See Liquor. 
Acida, 65, 189, 231, 290. 
Acidum aceticum, 106, 117, 144, 179, 205, 
228, 254, 265. 
arseniosum, 29, 65, 148, 180, 211, 

217. 
benzoicum,i87,23i, 232,265,269. 
bichloraceticum, 117. 
boracicum, 104, 182, 184. 
carbolicum, 54, 83, 92, 94, 97, 
100, 103, 106, 112, 117, 142, 
148, 149, 163, 164, 166, 174, 
178, 179, 181, 183, 184, 191, 
215, 217, 281, 282, 283, 284, 
290, 296, 298, 300, 311, 337, 

343. 346. 
carbonicum, 37, 149, 160. 

23 



ill, 
146, 

181, 

97, 
118, 



1 Acidem chromicum, iod, 103, 107, 

118, 179.- 
citricum, 215. 
gallicum, 61, 67, 14c, 145, 

202, 254. 
hydrobromidum, 277. 
hydrocyanicum dilutum, 66, 

183, 185, 217, 223, 274. 
muriaticum dilutum, 72, 95 

.201, 303, 315. 
nitricum, 92, 104, 107, 114, 

148, 179, 272. 
nitro-muriaticum, 189, 193. 
phosphoricum, 278. 
picricum, 338. 
pyroligneum, 106, 1 18. 
salicyiicum, 53, 168, 189, 279 

281, 282, 288, 347. 
sulphuricum aromaticum, 64, 
dilutum, 61, 69 
205,254,278, 
344- 
sulphurosum, 184, 288. 
tannicum, 31, 64, 69, 100, 

109, 119, 132, 164, 165, 

168, 188, 189, 211, 219, 

338, 347- 



147. 

95. 

3 2 4, 



104, 
166, 
337, 



354 



INDEX OF REMEDIES. 



Acidum tartaricum, 64, 95, 231. 
Aconitia, 184. 

Aconitum, 28, 41, 62, 93, 217, 222, 269, 
272, 273, 275, 279, 280, 287, 293, 300, 
302. 304, 310, 314, 318, 326. 
Acosta's gas cautery, 109. 
Actea alba, 249. 

racemosa, 326. 
Actual cautery, 107, 179, 193. 
Acupressure, 323. 
Aether — See Ether. 
Agaricus albus, 330, 335. 
Air pessary, 207. 
Alcohol, 148, 214, 224, 244, 255, 278, 287, 

295, 297, 298, 323, 344, 347. 
Alcohol as an anaesthetic, 238. 
Alimentation, rectal, 216. 
Alkalies with opium, 248. 
in cystitis, 189. 
in vaginitis, 167, 172. 
to favor absorption, 289. 
Alkaline baths, 52. 

carbonates, 174, 
purgative water, 231. 
Allium, 74. 
Aloes, 33, 35, 38, 40, 41, 5i, 74, 77, 79, 

168, 212, 227, 231, 272, 307. 
Aloes cum myrrha, 80. 
Aloin, 41, 226. 
Alterative applications, 96. 

lotions, 188. 
Althaea, 51. 

tents, 119. 
Alum en, 64, 65, 70, 109, 118, 149, 162, 

163, 167, 168, 259, 330, 335, 345. 
Alumen, objection to injections of, 168. 
Aluminse nitras, 184. 

Ammoniaemurias. .S><?Ammonii chloridum. 
Ammonii benzoas, 187. 

bromidum, 61, 65. 
carbonas, 231, 277, 280, 291. 
chloridum, 28, 30, 31, 41, 53, 
55, 63, 97, 144 145, 168, 184, 
222, 293,300,316,318,323. 
iodidum, 316. 
valerianas, 49. 
Ammonium, 74, 303. 
Amputation of cervix uteri, 125, 148. 
Amyl nitrite, 55, 244. 
Anaesthetics., 240, 272. 

in labor, 233, 235,236, 237. 
conclusions on, 235. 
propositions on, 237. 
Anisum, 335. 
Anodyne plasters, 323. 
Anthemis, 50, 75, 289, 303. 
Antigalactics, 328. 
Antimonii chloridum, 118. 
Antimonii et potassii tartras, 30,244,273, 

274, 280, 304, 312, 313. 
Antiphlogistics, 228. 
Antiseptic marine lint, 123. 



Antiseptic midwifery, 281. 

surgery of the mammae, 3 1 1. 
Antiseptics, 141, 276, 277, 279, 280, 290, 

293, 3"- 
Apiol, 40, 41, 46, 55. 
Aqua ammoniae, 41, 184, 289. 
bullientis, 51 . 
calcis, 184, 185, 345. 
fervida, 184. 
pimentae, 164. 
Arbor vitae, 179. 

Argenti nitras, 41, 92, 100, 102, 104, 105, 
108, 118, I49,i 6 5, 166, 169,173, 
177, 178, 179, 184, 188, 191, 194, 
216, 223, 224, 314, 335, 337, 

339, 340, 342, 344, 345- 
oxidum, 65. 
Armoracia, 217, 
Arnica, 277, 287, 289, 341. 
Arsenici iodidum, 148, 180, 323. 
Arsenicum, 323, 326. 
Arseniosum acidum. See Acidum. 
Artemisia vulgaris, 41. 
Artificial vesico-vaginal fistula, 188. 
Aspiration, 19. 

Assafcetida, 46,47, 51, 70, 73, 75, 204. 
Astringent injections, 173. 

lotions, 188, 313. 

tonics, 329. 

for nipples, 341. 
Atropia and Atropiae sulphas, 27, 30, 53, 
55,74, 178, 191,216,217,218,244,330. 
Atropine, 241. 
Aurantii flores, 75. 
Auri et sodii chloridum, 73, 75. 

Balsamum Peruvianum, 187, 338, 344, 345. 
Bandage, hypogastric, 123. 
Bandaging in mammary sinuses, 314. 

for swelling of arm, 323. 
Barnes' method for premature labor, 208. 
Barnes' rubber bag, 125, 239, 251. 
Baths, 45, 62, 82, 91, 147, 228. 
hot air, 229, 230. 
shower, 76. 
Turkish, 229, 230. 
Battey's operation, 30. 
Battley's solution, 200, 223, 242, 258. 
Belladonna, 27, 28, 42, 46, 47, 50, 55, 91, 
94, 104, 109, 161, 176, 177, 178, 192, 
194, 210, 214, 217, 225, 226, 244, 268, 
269, 285, 293, 302, 303, 310, 31 1, 313, 
316,318,323,326, 328, 329, 330, 331, 

335. 
Bennett's caustic, 119. 
Benzoinum, 344, 345. 
Berberiae sulphas, 66, 274. 
Bismuthi oxidum, 185. 
subacetas, 214. 

subnitras, 79, 95, 118, 162, 169, 
183, 215, 216, 217, 230, 342, 
346. 



INDEX OF REMEDIES. 



355 



Black cohosh, 221. 

Blisters, 30, 93, 104, 2SS, 293, 298, 300, 

3 OI > 3°3- 
Block tin pessaries, 127. 
Boletus, 334. 

Boracicum acidum. See Aciilum. 
Bougies, 48. 

Bourjeaud s pessary, 123. 
Brandy. See Stimulants. 
Braun's colpeurynter, 207, 239. 
Brick clny, 182. 
Brominium, 30, 55, 148. 
Buchu, 187, 188. 

Carlsbad salts, 182. 

Caffea, 327, 330 

Cajuputi oleum, 75. 

Calcii chloridum, 144, 146, 148,287. 

phosphas, 335. 
Calumbse infusum, 144, 216. 

tinctura, 79, 216, 217. 
Camphora, 26, 30, 50, 51, 52, 55^ 56, 75, 
112, 155, 181, 184, 271, 273, 291, 295, 
300,306, 316, 330. 331. 
Camphorse spiritus, 323, 

monobromidum, 155, 230, 
271. 
Canella, 166. 

Cannabis Indica, 26, 46, 55, 66, 75, 140, 
146, 155, 205, 211, 245, 260, 

273. 274, 33°- 
sativa, 330. 
Canquoin's paste, 107. 
Cantharides, 42, 167, 212. 
Capsicum, 260. 
Capsules, 103. 

Carbolic acid. See Acidum. 
Carbolized oil and lotions, 281, 285. 
Carbonate of ammonium. See Ammonii 

carbonas. 
Carbonate of lead. See Plumbi carbonas. 
Carbonic acid gas, 37, 149. 

how to prepare, 160. 
Carbonis sulphidum, 244. 
Carotids, compression of, 264. 
Caryophyllus, 345. 
Cascanlla, 164. 
Cassava, 334. 
Castoreum, 49, 72, 74. 
Castor oil bean, 334. 
Catechu, 64, 66, 169, 344. 
Cathartics, 76, 272. 
Catheter, use of, to induce premature labor, 

207, 210. 
Caulophyllum thalictroides, 244. 
Caustics, 106, 107, 119, 149, 150, 219, 324, 

325>342. 
Caustic arrows, 325. 

potassa, 92, 107, no, 149, 150, 

335- 
Cauterization of gums, 225. 
Cauterizing pencils of Bonnafond, 108. 



Cautery, actual, 150. 

galvanic, 108, 137. 
gas, 108. 

tliermo, 108, 150. 
Cerii oxalas, 216, 217. 
Cerium, salts of, 214. 
Cervix uteri, amputation of, 150. 
Chalk mixture, 226. 
Chamomile. See Anthemis. 
Charcoal pencils, n 1. 
Chloral, 47,60, 106, 151, 184, 188, 191, 
192, 202, 216, 217, 225, 232, 234, 238, 
240, 242, 245, 249, 264, 265, 266, 267, 
271,273,275,287,291,313,319. 
Chloralum, 260. 

cotton wool, 123. 

Chlorodyne, 200, 226, 248. 

Chloroformum, 75, 93, 144, 160, 185, 216, 

217, 223, 229, 233, 234, 

235, 236, 237, 238, 239, 

242, 243, 245, 264, 265, 

. 274, 303, 307, 315. 

injection of vapor, 161. 

in intermittent doses, 236. 
Chloroformi spiritum, 222, 276. 

linimentum, 306. 
Chromic acid. See Acidum. 
Churchill's tincture of iodine, 99, 140. 
Cicuta, 323. 

Cider vinegar, 144, 261, 287, 318. 
Cimicifuga, 42, 52, 53, 55, 66, 221, 245, 

275- 
Cinchonia, 63, 77, 78, 166, 222, 315, 327. 
Cinnamomum, 65, 66, 140, 242, 245. 
Citric acid. See Acidum. 
Civeolia levigata, 342. 
Clitoridectomy, 156. 
Cloth tents, 119. 

Clothing in the puerperal state, 197, 198. 
Cloves, 345. 

Cocculus indicus. 55, 79, 169. 
Cochlearia tinctura, 225. 
Codeia, 182. 

Cod liver oil, 29, 326, 335. 
Coffee, 327, 330. 
Cohen's method for inducing premature 

labor, 208. 
Colchicum, 52, 53, 55, 183, 328, 329, 330. 
Cold, 70, 76, 172,191,254,260, 261, 262, 
270,271, 279, 301, 316, 317, 319, 

• 329- 

affusions, 26, 214. 

douche, 240, 254. 

water enemata, 205. 

injections for hemorrhage, 251. 

poultices for vaginal growths, 180. 
Colocynth extract, 226. 
Collodium, 329, 345, 346, 347. 
Colpeurynter, 209,250, 253,254. 
Compound licorice powder, 294. 

m gnesia powder, 294. 
Compresses, 303. 



35^ 



INDEX OF REMEDIES. 



Compression of abdominal aorta, 257, 262. 
in mammary inflammation, 

3I9- 

for swelling, 302. 
tumors, 290, 324. 
Condom, the, for puerperal hemorrhage, 

252. 
Condy's fluid, 141, 276, 279, 280. 
Confectio sulphuris, 226. 
Conger eel soup, ^^. 
Conium, 155, 271, 299, 319, 329, 331. 
Constipation, diet for, 226. 
pills for, 226. 
Copaiba, 162, 167, 187. 
Cork powder, 337, 347. 
Corn sow-thistle, 334. 
Corn-stalk pith tents, 1 19. 
Coronilla juucia, 334. 
Cow basil, 334. 
Coxeter pessary, 123. 
Creta prseparata, 304, 306. 
Creasotum, 92, 118, 185, 217. 
Crayons, 102, 106, 108. 
Crocus sativus, 38, 42, 56. 
Cubeba, 167, 173. 
Cupping, 63, 76, 230, 278, 296. 
Cupri acetas, 179. 

sulphas, 75, 100, 118, 169, 217, 313. 
Curette, the, 60. 

hand as a, 258. 

Thomas', 115. 
Curved sponge tents with spring, 133. 
Cusparia cortex, 75. 
Cypripedium, 52. 

Deer balls, 334. 

De Vigo's piaster, 323. 

Depletion, local, 92. 

Diaphoresis, 270. 

Diaphoretics, 239, 301, 305. 

Dialyzed iron, 293. 

Diet in albuminuria, 228,231. 

mammary tumors, 322. 

peritoniti?, 299, 

vaginitis, 172. 

for agalaxia, 335,336. 

for nursing women, ^^. 

for sterility, 154 

for puerperal women, 197, 198, 

304, 307- 
regulation of for non-malignant 

growths, 140. 
to restrain the milk secretion, 327. 
to prevent mastitis, 317. 
Digestive tonics, 95. 
Digitalis, 61, 146, 155, 232, 239, 272, 289, 

3 ! 3> 3 J 9- 
Dilatation of cervix uteri, 70, 124. 
os uteri, 94, 216. 
os uteri with the finger, 246. 
os uteri by graduated fluid 
pressure, 208. 



Dilatation of urethra, 194. 
vagina, 176. 
rapid, of canal of uterine neck, 
58, 66. 
Dilator bag in labor, 243. 
Dilators in rigid os uteri, 239. 
Diluents in albuminuria, 231. 
Diuretics, 228, 267, 299. 
Division of cervix uteri, 93. 
Drastics, 266, 267. 
Dry heat, 317. 

Ecbolics, 212. 

Ecraseur, 138. 

Emmet's, 138. 

Elaphomices granulatus, 334. 

Elastic pressure, 130. 

Elaterium, 265, 266. 

Electricity, 33, 36, 44, 54, 76, 145, 219, 
247, 255, 262, 303, 333. 

Electrolysis, 32, 147. 

Emetics, 76, 272. 

in abortions, 212. 

Emmenagogues, 33, 210, 334. 

Emollient applications, 96. 

Emplastrum plumbi, 346. 

Enucleator, Emmet's, 138. 

Enemata, 30 ; cold, 227. 

of broth, oil and wine, 218. 

Ergota, 36, 40, 42, 54, 56, 61, 65, 66, 79, 
8^, 142, 143, 146, 167, 201, 204, 
211, 212, 242, 243, 245, 251, 254, 
255, 25b, 257, 260, 268, 296, 306, 

3°7,3 I 9> 33 1 - 
with morphia, 244. 
Ergotine, 29, 82, 142, 166, 201, 203. 

suppositories, 145. 
Erigeron canadense, 260. 
Essentials to the arrest of puerperal hem- 
orrhage, 260. 
Ether, 74, 155, 217, 273, 289, 346. 

hypodermically," 252, 257, 260. 
spiritus, 223. 
Excision of growths, 179. 
Exercise, 33, 35. 

in the puerpei-al state, 197, 198. 
Extractum colocynthidis, 226. 
Extractum colocynthidis compositum, 284, 

3°7- 
Faradic current, 145. 
Faradisation, 332, 336. 
Feculum, 169, 186, 281, 282. 
Fehling's mixture, 282. 
Fennel, 335. 
Ferri ammoniata, 335. 

bromidum, 69, 155. 

carbonas, 77, 78. 

chloridum, 63, 65, 100, 106, 149, 180, 

258, 259, 260. 
chloridi tinctura, 55, 62, 69, 79, 100, 
. 118, 144, 169, 185, 228, 261, 272, 
296, 3°7> 3 I 5» 3 ?6 - 



INDEX OF REMEDIES. 



357 



Ferri et ammonii citras, 149. 
quiniae citras, 78, 222. 
iodidum, 54, 79. 
lactas, 335. 

mistura composita, 79. 
oxalas, 79. 
subcarbonas, 166. 

subsulphas, 11S, 150, 180, 261, 2S7. 
liquor, 109, 144, 148, 
227, 261. 
sulphas, 39, 79, 90, 91, 95, 165, 166, 
227, 261. 
exsiccatum, 226. 
vinuni, 55, 79. 

amarum, 7S, 95. 
valerianas,326. 
Ferrum, 67, 75, 104, 146, 231, 232, 303, 
328, 329- 
redactum, 42. 
Filho's caustic, 107, 119. 
Fish diet, 230, 333. S 

Fceniculum, 335. 

Fomentations, 166, 226, 299, 336. 
Food. See Diet. 
Forceps, the, 242, 243, 290, 291. 

in rigid os uteri, 239. 
Forcible dilatation of cervix uteri, 124. 
Friar's balsam, 342. 
Frictions, mercurial, 2S0. 
Frigus. See Cold. 
Fucus crispus, 161. 
Fuller's earth, 342. 
Fungi, edible, 333. 

Galactogenic agents, 332, 323. 

Galbanum, 42, 73, 75, 323. 

Galla, 167. 346. 

Gallega officinalis, 332, 336. 

Galvano-cautery, 108, 137. 

Galvanic pessary, 47, 54. 

Galvanism. 57, 121, 147, 210, 242, 254, 

262. 
Gariel's air pessnry, 207. 
Gas-cautery, 108. 
Gastric juice dressing, 14.8. 
Gehrung's pessaries, 135. 
Gelsemium sempervirens, 54, 62, 172, 245. 
Gentian-root tents, 120. 
Gentian, 91. 

Genu-pectoral position, 53, 130, 154. 
Glycerina, 100, 107, 141, 142, 162, 169, 

290, 298, 315, 343, 346. 
Glycerine ot borax and sulphurous acid, 

224. 
Glycerole of borax, 225. 
iodine, 148. 
lead, 346. 

tannin, no, 338, 344, 346, 
Glyceroles, 103, 161. 
Gossypium, 56, 212. 
Goulard's extract, 178, 323, 324. 
lotion, 223. 



Granati radicis cortex, 169. 
Greenhalgh's flexible pessary, 1 25. 
spring pessary, 125. 
Guaiac, 56. 
Gutta percha collodion, 329. 

Hamamelis, 59, 67. 
Hsematoxyli lignum, 167. 
Hard-rubber pessary, 197. 
! Heat, 70, 220. 262, 300. 
; Helleborus album, 274. 
nigrum, 56. 
Helonias, 54. 
Hemostatics, local, 258. 
Hicks' wire-rope ecraseur, 137. 
Hip baths, 26, 33, 247. 
Hedge's lever pessary, 124, 127. 
Hot bath for puerperal hemorrhage, 252. 
fomentations, 311. 
sand-bags for puerperal hemorrhage, 

253- 
water douche, 239, 240. 

injections, 249, 294. 
vaginal injections, 197. 
Humulus, 313. 
Hydrargyrum, 300. 

Hydrargyri chloridum corrosivum, 63, 96, 
97, 140, 146, 169, 
179, 185, 204, 
224, 293, 300. 
mite, 42, 190, 266. 
268, 271, 274, 
280, 284, 295, 
299, 346. 
iodidum rubrum, 146. 

viride, 148. 
oxidum rubrum, 185. 
nigrum, 214. 
Hygiene, puerperal, 194. 
Hyoscyamus, 28, 156, 187, 217,226, 227, 

248,249, 251,271,273, 276,307. 
Hypodermic use of ergot, 143, 146. 

ether, 252, 257. 260. 
morphia. See Morphia. 

Ice, 30, 59, 62, 70, 178, 230, 232, 254, 

267, 289, 290, 299, 317, 319. 
Ice bag, 299,317, 319. 
Ignipuncture, 108. 
Incision of breast, 309. 

in rigid os uteri, 239, 243, 247. 
Ingluvin, 217. 
Injections, astringent, 122. 

hot water, 91, 126, 128, 301. 
of iron, etc., into the womb, 

91, 98, 99, 258, 259, 260. 
of warm water into vagina, 247. 
rectal, 230. 
vaginal, 173, 220. 
Instrument to remove ovum, 205. 

place tents, 207. 
Interstitial injection of iodine, 112. 



358 



INDEX OF REMEDIES. 



Intra-uterine dilator, 209. 
douche, 208. 

injection of ergot. See In- 
jections. 

hot water. See In- 
jections, 
in puerperal hem 
orrhage, 255. 
tents, 103. 
Iodide of ammonium, 315. 

potassium, see Potassium. 
Iodine liniment, 29. 

Iodinii tinctura, 106, 113, 145, 160, 165, 
170, 214, 215, 216, 223, 293, 303, 309, 
318, 319^23- 
lodinium, 30, 31, 42, 93, 99, 100, IOI, 
104, 118, 141, 145, 147, 170, 185, 217, 
287, 300, 313, 315, 317, 323, 331, 335. 
Iodized cotton, I n. 
phenol, 97. 
Iodoformum, 42, 83, 102, 103, 104, 106, 

118, 151, 176, 177, 178,347. 
Iodo-tannin, 145. 

Ipecacuanha, 61, 67, 162, 191, 217, 227, 
245, 251, 261, 272, 274, 

293 : 3°7, 3I3- 
et opii, 309. 
Iron increases tendency to hemorrhage, 

137, 140. 
Iron injections into the womb. See injec- 
tions. 
Inspissated ox-gall, 226. 
Ivory, tents of, 120. 

Jaborandi, 212, 232, 268, 269. 
Jalapa, 214, 231, 264, 266, 274, 307. 
Jatropha manihot, 334. 
Juniperus, 167. 

Kiwisch's ascending douche, 209. 
Knee-and-chest position, 53, 130, 154. 
Knot ties, Carroll's, 115. 
Krameria, 64, 65, 68, 167,177,178, 338, 347. 
Krause's method for premature labor, 208, 

210. 
Kumyss, 229. 

Labor, antiseptic management of, 280. 
Lactopeptin, 217. 
Lactucarium, 248. 
Laminaria tents, 94, 120. 
Laurel water, 328. 
Lavandula, 52, 75. 
Laxatives for puerperal women, 307. 
Leeches, 26, 30, 44, 94, 147, 174, 220, 
267, 286, 293, 296, 299, 301, 303, 312, 

323- 

Lemon for puerperal hemorrhage, 25 1 : 
Lentils, 333. 

Ligation of varicose veins, 255. 
Linimentum ammonias, iodidi et chloro- 
form i, 315. 



Linimentum chloroformi et belladonna?, 
248. 
camphorae compositum, 93. 
saponis camphoratum, 302, 

307. 
Liquor ammoniae acetatis, 37, 49, 55, 81, 
83, 228. 
citratis, 79. 
arsenici chloridi, 97. 
calcis, 183, 339, 346. 
hydrargri nitratis, 105, 107, 1 18, 

141, 150, 179, 324. 
iodinii compositus, 101, 303. 
ferri chloridi, 47, 251. 

suhsulphatis, 63, 100. 
morphiae sulphatis, 223. 
plumbi subacetatis, 181, 186, 289, 

303.337, 338,345. 

potassae, 77, 80. 

potassse arsenitis, 78, 203. 

sodae chlorinatae, 165, 186, 296. 

strychniae, 78, 114, 222. 
Lister's antiseptic method, 311. 
Lobelia, 62, 245. 
Local applications, 140. 
Local blood-letting, 121. 
Lotions, 172. 
Lupulina, 29, 75, 156, 249. 

Magendie's solution of morphia, 278, 297. 
Magnesia, 217. 
Magnesii citras, 215, 229. 

sulphas, 68, 95, 229. 
Maize, ergot of, 143. 
Mammary excitation, 262. 
Manipulation, 76. 
Manual pressure in labor, 242. 
Marine lint, 115. 

Marital relations in pregnancy, 199. 
Marriage as a remedy, 47, 48. 
Massage, 45. 

of the uterus, 104, 262. 
Matico, 62, 68, 82, 84, 170. 
Mechanical dilata'ion of os uteri, 209. 
Medical treatment of tumors, 142. 
Medicated pessaries, 161, 162, 166. 
Mental conditions in pregnancy, 199. 
Menthae oleum or essentia, 186. 
Mentha pulegium, 43. 
Mercury, 299, 322. 

Milk diet, 45, 187, 229, 230, 232, 293. 
Mineral acids, 204, 278. 

waters, 147, 229. 
Mistletoe, 69, 146, 240, 246, 261. 
Mistura potassii citratis, 293. 
Morphia, 26, 27, 47, 53, 145, 161, 173, 

186, 188, 215, 218, 248, 266, 

269, 273, 286, 287, 292, 293, 

294, 295, 300. 
used hypodermically, 231, 238, 

239, 240, 243, 297, 303. 
Morphia; murias, 186, 223, 227. 



INDEX OF REMEDIES. 



359 



Moschus, 75. 
Myrrha, $S, 43. 

Narrowing the vagina, 124, 125. 
Neutral mixture, 293. 
Nitrite of amy I, 261. 
Nitrous oxide gas, 221, 238. 
Nux vomica, 91, 95, 218, 226, 230, 307. 
Nutrition. Ssc Diet. 
Oak bark, 162. 
Ointments, 27, 102. 
Oldham's ointment, 181. 
Oleum carbolizatum, 280, 281. 
cajuputi, 75. 
olivae, 186. 

morrhuae, 29, 326, 335. 
ricini, 226, 246, 293. 
terebinthinae. See Terebinthinae. 
tiglii, 232, 265. 
Opium, 26, 30, 47, 49, 50, 51, 57, 61, 109, 
140, 162, 166, 174, 178, 187, 2CI, 202, 
203, 204, 211, 218, 230, 239, 240, 243, 
246, 248, 249, 254, 255, 268, 269, 271, 
273, 276, 278, 280, 285, 287, 289, 293, 

295, 2 97- 
Opii, extractum, 77, 78, 214. 

tinctura, 205, 251, 291. 302, 303. 
deodorata, 300. 
Ovariotomy, 30. 
Oxalas, ceiii, 214. 
Oxytocics, 240, 242, 255. 

Paquelin, thermo-cautery of, 150. 
Paracelsus, elixir of, 43. 
Pareira brava, 189. 
Pencils, 102, 106. 
Pepsin, 215, 218, 230. 

Pessaries, 30, 47, 54, 103, 122 et seq. 126, 
134, 135, 197, 207. 
medicated, 173, 174, 216. 
rules for use of, 131. 
Pilocarpin, 212, 232, 269. 
Pinceaux, 101. 
Pinus canadensis, 191. 
Pix liquida, 112, 1 19, 186. 
Placenta forceps, 206. 

separation of, 25 1. 
Pledgets, 101. 
Plugs of charpie, 177. 
Plugging neck of the womb, 63. 

vagina, 209, 250. 
Plumbi acetas, 65, 109, 166, 170, 174, 181, 
183, 188, 202, 205, 211, 254, 
261. 
iodidum, 31, 109, 150, 161. 
permanganas, 166. 
subacetas, 170. 
Plumbum, 178. 
Podophyllum, 36. 
Porte-tampon, 161. 
Position in hemorrhage, 140. 
labor, 242. 
swelling of leg, 303. 



Potassa cum calce, 30. 
fu>a, 105, 1 19. 
Potassii acetas, 183, 228, 230, 232. 

bicarbonas, 175, 193, 215, 295. 
bitartras, 228. 229, 232. 
bromidum, 28, 29, 30, 43, 47, 57, 
68, 75, 81, 90, 113, 147, 156, 
173, 216, 218, 224, 230, 232, 
249, 265, 266, 267, 270, 272, 
2 73» 275, 278. 
chloras, 31, 163, 169, 170, 173, 

201, 225, 274, 278, 303. 
citras, 193. 

iodidum, 27, 31, 37, 93, 99, 100, 

ior, 107, 113, 119, 147, 148, 

164, I75» I79» 214, 218, 300, 

328. 

nitras, 57, 108, 167, 175,272,295, 

300. 
permanganas, 149, 163, 176, 277, 

283, 288, 299. 
sulpho-carbolas, 277. 
"Potion de Riviere," 215. 
Poultices, 26, 95, 171, 248, 276, 293, 294, 

299, 301,303. 
Powders, 103. 

Premature labor, method for, 206, 207. 
Pressure by hand in hemorrhage from 
womb, 255. 
in uterine disease, 
97, 141, 147. 
Prophylaxis of eclampsia, 265. 
Pulsatilla, 40, 43, 167, 170. 
Pulvis jacobi veri, 295. 

glycyrrhizse compositum, 226. 
jalapse compositum, 228, 229. 
Punctures, 1 10. 

Puncture of membranes to induce labor, 
209. 
for hemorrhage, 250. 
Purgatives, 270,, 272 288. 

Quercus alba, 70. 170. 

Quinia, 28, 50, 69, 77, 91, 147, 211, 212, 
223, 276, 277, 278, 279, 285, 
286, 288, 290, 292, 293, 295, 
297, 298, 300, 303. 
in labor, 240. 

•" Ready method" for puerperal hemor- 
rhage, 253. 

Rectal injections, 192. 

Reflex action for premature labor, 210. 

Rest, 172, 174, 189, 289, 301. 

Rhatany, extract of, 167. 

Rhei, extractum, 78, 91. 
vinum, 222. 

Rheum, 68, 226, 268. 

Richardson's styptic colloid, 109, 1 13. 

Rufus, pills of, 42. 

Rupture of membranes to hasten labor, 
242. 



360 



INDEX OF REMEDIES. 



Ruta graveolens r 40, 43, 75, 213. 

Sabina (savine), 38, 40, 43, 69, 168, 211, 

213. 
Sabina oleum, 36. 
Saffron, 36. 
Salicin, 218. 
Saline aperients, 274. 
Santoninum, 75. 
Sapo, 227. 

Saponified coal tar, 161. 
Sassafras, 162. 
Scammonium,2i4. 

Scheel's method for premature labor, 2IO. 
Scutellaria, 51. 
Seltzer water, 231. 
Senega, 44. 
Senna, 40, 216, 315. 
Separation of membranes for premature 

labor, 211. 
Separation of placenta in puerperal hem- 
orrhage, 253. 
Setons, 27. 
Sinapis, 44, 57. 
Sinapisms. 262. 
Slippery- elm bark tents, 120. 
Smith's modification of lever pessary, 134. 
Soda, chlorinated, 296. 
Sodii boras, 38, 44, 80, 162, 170, 181, 
186, 187, 213, 225, 246, 340. 
benzoas, 288. 
bicarbonas, 37, 223, 299. 
bromidum, 265, 270. 
carbonas, 170, 179. 
et potassae tartras, 95. 
salicylas, 188, 279, 283, 285, 288. 
sulphis, 186. 
Spiritus aetheris chlorici, 72. 

nitrosi, 75. 272, 304. 
compos tus, 56. 
ammoniae aromaticus, 222. 

foetidum, 73. 
lavandulae compositus, 74. 
rosmarini, 185. 
Sponge tents, 70, 120, 133. 

to dilate a rigid os uteri, 

242. 
for premature labor, 206 
Spring tents, 133. 
Squaw weed, 260. 
Starch, 169, 186, 281, 282. 
Stem pessaries, 124. 
Stimulants. See Whisky. 
Stramonium, 28, 52, 53, 178, 227, 275. 
Strychnia, 37, 44, 78, 90, 91, 142, 191, 219. 
Styptics, 251. 
Styptic glycerine, 250. 
Sulpho-carbolates, 188. 
Sulphuris, 40, 80,281. 
Sulphur, electuary, 227. 
Sumbul, 72. 
Suppository, rectal, 187. 



Suppositories, 109, 122, 145, 174, 177, 

220. 
Sutures, uterine, 115. 

Tabacum, 162, 186. 

Tamarind um, 64. 

Tampon for cystitis, 188, 204, 

Tampons, medicated, 161, 163. 

Tanacetum, 44, 186, 2)3. 

Tannin, 107, 109, 171, 178, 191, 231, 253, 

254, 289. 
Tannin, bougie, 190. 
Taraxacum, 57. 
Tartar emetic ointment, 26. 
Tents, in dysmenorrhea, 53. 

ivory, 120. 

gentian root, 120. 

laminaria, 94, 120. 

rules for use of, 116. 

sea-tangle, 116. 

slippery elm bark, 120. 

tupelo, 120. 

uterine, 103, 1 19, 206. 

to induce labor, 209, 210. 

action in non-malignant growths, 

141. 
Tepid bath, 231. 
Terebinthinae oleum, 30, 44, 57, 69, 72, 75, 

168, 187, 202, 211, 288. 
Thea, 171. 

Thermo-cautery, 108, 150. 
Thuja occidentalis, 179. 
Thymol, 150, 182, 186, 277, 288. 
Thymolized clay, 131, 182. 
Tinctura belladonna?, 223. 

benzoini compositum. T,37> 34-6- 

camphorae, composita, 223. . 

cardamomi composita, 223. 

castorei, 74. 

ammoniata, 73. 

chloroformi composita, 223. 

cinnamomi, 307. 

conii, 188. 

ferri chloridi. See Ferri. 

gallae, 145. 

gentiana, 1 14. 

hyoscyami, 186. 

iodinii. See Iodine, 
composita, 284. 

nucis vomicae, 78, 193, 255, 296. 

opii. See Opium. 

opii deodorata, 61. 

sabinae composita, 164. 

sumbulis, 223. 

Valerianae ammoniata, 223. 
Tobacco, 162, 186. 
Tormentilla, 171. 

Torsion of the abdominal walls, 76. 
Traction on lip of os uteri to cause dilata- 
tion, 239. 
Transfusion, 262. 
Triticum repens, 149, 189. 



INDEX OF AUTHORS. 



3 >i 



Trocar to puncture the membranes, 209. 

Tupelo tents, 120. 

Turning in hemorrhage, 250. 

in placenta praevia, 254, 255. 

Ulmus, 162. 

Unguent urn gallae cum opii, 229. 

hydrargyri, 109, 185, 299, 

iodidi, 303. 
petrolei, 183. 
Urtica, 69, 82, 84. 
Uterine douche, III. 

exonerants, 212. 
injections, 98. 
sedatives and lotions, 211. 
Ustilago maidis, 143, 147,246. 
Uva ursi, 189. 

Vaginal cataplasms, 161. 

injections, 160, 168. s 

irrigations, 160. 
suppositories, 161. 
Valeriana, 49, 51, 71, 72, 75. 
Vapor baths, 231. 
Varicose veins, ligation of. 255. 
Vaseline, 1S2, 191. 

inunctions, 229. 
Venesection, 229, 230, 243, 247, 264, 265, 
266, 267, 268, 269, 270, 272, 274, 280, 
288, 299. 



Veratria, 27, 57, 93, 104. 

Veratrum viride, 62, 270, 272, 273, 277, 

284, 288, 297, 300. 
Viburnum prunifolium, 57, 69, 211. 
Vichy water, 23 1. 
Vienna paste, 107. 
Vinca major, 147. 
Vinegar, 202, 258. 

injections, 231. 
Viscum album, 69, 146, 240, 246, 261. 

Wallace's spring sponge tents, 133. 
Warburg's tincture, 279, 288. 
Warm bath as a sedative. 273. 

fomentations to the .lead for puerpe- 
ral hemorrhage, 253. 

sitz bath, 1 91. 

water injections, 173. 
Weiss' female urethral dilator, 194. 
Whisky, 219, 272, 279,293, 297, 298, 299. 

Zinci bromidum, 156. 

Zinci chloridum, 119. 

Zinci chloridi liquor, 173. 

Zinci oxidum, 69,76, 109, 17 1, 183, 186. 

Zinci sulphas, 64, 69, 76, 101, 102, 104, 

107, 109, 119, 162, 171, 177, 188. 
Zinci sulpho-carbolas, 182. 
Zinci valerianas, 73, 74. 
Zingiber, 44, 164, 216, 239. 
tinctura, 222. 



INDEX OF AUTHORS. 



Abegg, 335. 

Acosta, Mr., Paris, 109. 

Aitken, Wm., Edinburgh, 71. 

Alexander, L., Pennsylvania, 56. 

Allen, Joshua G., Philadelphia, 329. 

Althaus, Julius, 44, 333. 

Amussat, 141. 

Andrews, R. H., Pennsylvania, 66. 

Anstie, F. E., London, 41, 55, 3^6. 

Anselmier, 345. 

Aran, F. A., Paris, 49, 69, 

Arnold, A. B., Baltimore, 72. 

Ashhurst, John, Jr., Philadelphia, 146. 

Ashwell, S , London, 42, 57, 79, 170. 

Asp, G., Helsingford, 104. 

Atlee, Washington L., Philadelphia, 141, 

145- 
Atthill, Lombe, Dublin, 18, 27, 23, 45> 
67, 78, 92, no, 118, 119, 124, 138, 142, 
158, 162, 168, 169, 170, 218, 251. 259, 
260, 261, 262. 



Aust-Lawrence A. E., Bristol, Eng., 151. 

268. 
Aveling, J. H., London, 262. 

Bacarisse, 214. 

Bailly, Dr., Paris, 252. 

Baird, A., Edinburgh, 288. 

Barker, Fordyce, New York, 83, 211, 227, 
232, 255, 265, 274, 277, 290, 294, 301, 
302, 304, 306, 307, 308, 326, 336. 337, 

346, 347- 
Barnes, Robert, London, 37, 55, 59, 69, 

81, 8^, 85, 94, 102, 138, 189, 208, 209, 

239, 259 261. 
Bartholow, Roberts, Philadelphia, 28, 61, 

217, 218, 237, 275, 288, 300, 301. 
Bartlett, Dr., New York, 83. 
Battey, Robert, Rome, Ga., 97, 103. 
Bayes, Dr., 154. 
Beach, R. E., Illinois, 113. 
Beck, Snow, 261. 



362 



INDEX OF AUTHORS. 



Becquerel, M., 333. 

Bedford, G. S., New York, 179. 

Bell, Robert, Glasgow, III, 119, 145. 

Bennett, J. H. Wauseon, Ohio, 240. 

Bennett, J. M., Liverpool, 112. 

Bernutz, 299, 300. 

Berry, Wm., Edinburgh, 267, 328. 

Binz, Prof., Bonn, 1 13. 

Bischoff, 280. 

Bixby, Geo. H., Boston, Mass., 169. 

Black, J. R. Newark, Ohio, 65, 184. 

Blacquieres, Dr., France, 338. 

Blandford, 273. 

Boer, M., 303. 

Boinet, A A., Paris, 31, 164. 

Bond, Henry, Philadelphia, 206. 

Bonnaford, 108. 

Bouchut, E., Paris, 177, 178. 

Bourdell, M., 344, 345. 

Boys, Wm., Waverly, Iowa, 317. 

Brabazon, Dr., 194. 

Braithwaite. Jas., 246. 

Braun-Fernwald, Vienna, 186. 

Braun, Carl, Vienna, 209, 231, 239. 

Bretonneau, Dr., France, 77, 214. 

Brisbane, Jas., London, 253. 

Brochard, M., 337. 

Brodie, Sir Benj., 75. 

Brown, I. Baker, London, 156, 178. 

Brown-Sequard, Paris, 75. 

Brunninghausen, 209. 

Bumstead, F. J., New York, 179. 

Burns, Robert, Philadelphia, 69, 203. 

Busey, S. C, Washington, 218. 

Butt, R. L., Alabama, 186. 

Buys, Dr., Bordeaux, 164. 

Campbell, C. J., Paris, 236. 

Campbell, Henry F., Augusta, Ga., 216. 

Cazeaux, M., Paris. 227. 

Chambers, Thos. King, London, 72. 

Championnierre, M. Lucas, Paris, 236. 

Charles, Dr., Belgium, 184, 226. 

Chapman, John, London, 70. 

Charcot, 156. 

Charriere, Dr., Paris, 338, 347. 

Christison, Alex., 245, 260. 

Christie, David, England, 262. 

Churchill, F., Dublin, 66, 79, 140, 205, 

210, 211, 236,312, 344. 
Clarke, Charles, London, 43, 164. 
Clarke, Daniel, Canada, 261. 
Clay, Charles, London, 210, 220. 
Cleaver, PL T., Keokuk, Iowa, 282. 
Clendenning, 21 1. 
Coe, A. S., New York, 230. 
Cohen, 208. 

Cooper, Astley, London, 171. 
Copeman, E , Norwich, Eng., 124, 216. 
Copland, Dr., 44, 80. 
Conteux, 330. 
Courty, A., Paris, 40, 43, 118, 166, 235. 



Coxeter, 123. 

Craig, Prof., Washington, 79. 
Craig. W., Edinburgh, 226. 
Crawcour, J. I., New Orleans, 284. 
Curran, J. Waring, Dublin, 27, 66, 76. 
Cutter, Ephraim, Boston, Mass., 32, 140, 
335- 

DaCosta, J. M., Philadelphia,^. 
Darby, J. T., New York, 172. 
Da Venezia, Dr., Italy, 219. 
Davis, N. S., Chicago, Illinois, 52. 

Davis, , 260. 

Delauny, Dr., 269. 

Demarquay, J. N., Paris, 165. 

D'Espine, 304. 

Desprez, A., Paris, 51. 

Dewees, W. P., Philadelphia, 55, 68, 

167, 169. 
Dezon, 214. 
Dickinson, W. H., 66. 
Dillenberger, Emil, Vienna, 37, 50, 64. 
Diboue, Dr., 219. 
Donovan, Wm., Edinburgh, 260. 
Doutrepoint, 329. 
Dubelski, Dr., Warsaw, 218. 
Dubois, Paul, 212. 
Duncan, J. Matthews, London, 18, 48, 

267. 
Dunster, E. S., Ann Arbor, Mich., 151, 

229. 
Druitt, Robert, London, 338, 344. 
Drysdale, Chas. R., London, 48. 
Drysdale, Thomas M., Philadelphia, 20. 

Eckland, Dr., Sweden, 100. 

Edis, A. W., 179. 

Edis, Thos., London, 130, 154, 163. 

Edwards, Dr., Denbigh, 124. 

Ellis, Robert, London, 105. 

Elsasser, 345. 

Emmet, Thos. Addis,, New York, 126, 

138, 150, 188, 191. 
Etheridge, J. H., Chicago, 111., 85. '87. 
Eulenberg, Albert, Berlin, 214, 215. 

Fehling, H., Leipsic, 269, 281. 

Field, Henry M., Boston, Mass., 79, 167. 

Fifield, Dr., Weymouth, 328. 

Finch, T., Illinois, 163. 

Flint, Austin, sr., New York, 71. 

Fonnsagrives, J. B., Paris, 37, 49, 82, 1 68, 

178, 212, 231,331, 332. 
Forwood, W. S , Darlington, Md., 216. 
Fothergill, J. Milner, London, 28. 
Fournier, M., Paris, 171. 
Frachaud, Dr., 234. 
Frankel, Dr., Breslau, 244. 
Frisbie, C. W., East Springfield, N. Y., 51. 
Fntsch, Halle, 282. 
Fritz, Dr., Paris. 39. 
Fuller, C, 218. 



INDEX OF AUTHORS. 



363 



Gaillard, Dr., Paris, 77. 

Galabin, N. L., London, 147, 157. 

Gallard, M. T., Paris, 106, 176. 

Gallois, F. A., Paris, 145. 

Gardner, Dr., 329. 

Garratt, A. C, Boston, Mass., 181. 

Gazzo, Jno. B. C, Thibodaux, La., 314. 

Gehrung, Eugene C, St. Louis, Mo., 135, 

188. 
German Pharmacopoeia, 74. 

Hospital, Philadelphia. 339. 
Gilbert, S. F., Elysburg, Pa., 189. 
Gill, D., St. Louis, Mo., 184. 
Glover, Jas. G., London, 276. 
Goldsmith, W. T., Georgia, 119, 120. 
Godson, Clement, London, 125, 206. 
Gooch, 272, 273. 
Goodell, Wm., Philadelphia, 67, 117, 120, 

124, 146, 147, 179, 192, 292. 
Goolden, Dr., 328, 329. 
Graham, Douglas, Boston, Mass., ^5. 
Graves, R. J., Dublin, 34, 76. 
Greene, Dr., Dorchester, 220. 
Greenhalgh, Dr., 11 r, 120, 124. 
Griffith, G. De Gorrequer, London, 141. 
Gross, Samuel D., Philadelphia, 322. 
G rune wall, 304. 
Guadriot, Dr., Paris, 173. 
Guipon, Dr., Paris, 166. 

Hall, Marshal], London. 154. 

Halton, Dr., Dublin, 114. 

Hamburger, Dr., 161. 

Hamelin, E., 43, 213. 

Hamilton, Dr., Edinburgh, 207. 

Hardy, Dr., 182, 344. 

Harris, Robert P., Philadelphia, 200, 227, 

233. 238, 265, 336. 
Harrison, Geo. T., New York, 256. 
Hartshorne, Henry, Philadelphia, 44, 51. 
Haussmann, Dr., Berlin, 337, 346. 
Hayes, P. S., Chicago, 111., 44. 
Hauck, 335. 

Herrick, O. E. Greenville, Mich., 121. 
Hewitt, Grailly, London, 26, 42, 62, 68, 

75, 78, 86, 148, 153, 170, 179, 184, 185, 

189,304. 
Hicks, Braxton, 119, 149, 182, 261. 
Hildebrandt, 143, 146. 
Holt, Joseph, New Orleans, 283. 
Hoist, 178. 
Home, 43. 

Horton, H. L., New York, 241, 244. 
Hopkins, 209. 
Hospitals of Paris, 132. 
Hospital of University of Pennsylvania, 

39- 
Howe, J. \V., New York, 263. 
Huguier, Dr., France, 27. 
Huebner, Dr., Dresden, 319,338. 
Hunt, Harry, Dartmouth, England, 211. 
Hunter, E. H. W., Georgia, 31. 



Huter, 209. 

Image, F. E., 217. 

Izard, Walter, Liberty, Va., 282. 

Jackson, A. Reeves, Chicago, 111., 182. 

Jacobi, Mary Putnam, New York, 55. 

Jacquet, 270. 

Jaret, Dr., 41. 

Jenks, E. W., Chicago, 111., 57, 212. 

Jewett, Theodore, Bowdoin College, 50. 

Johnson, Dr., 344. 

Johnson, W. B., Alabama, 84. 

Jones, G. S., Boston, Mass., 181. 

Jones, M. O., Chicago, 111., 216, 219. 

Joulin, 335. 

Kammerer, Joseph, 10 1. 

Keating, W. V., Philadelphia, 146. 330. 

Keifer, C. B., Indiana, 316. 

Kelly, Bernard, London, 248. 

Kerr, E. W., England, 26 r. 

Kimball, G., Lowell, Mass, 32. 

Kinsman, D. N., 104. 

Kirkpatrick, J. R., Dublin, 131. 

Kiwisch, 209, 335. 

Klebs, Prof., Prague, 288. 

Kluge, Dr., 209. 

Koeberle, Prof., 19, III, 1 18. 

Koehler, Dr., Germany, 253, 262. 

Koening, Dr., 319. 

Krause, 208. 

Kucker, Dr., Germany, 290. 

Kunst, A. II., Weston, W. Va., 271. 

Kurz, Edgar,. Tubingen, 317. 

Lane, John Wm., London, 329. 

Lange, 335. 

Langlebert, Edmund, Paris, 165. 

Larrabee, J. A., Louisville, Ky., 287. 

Laycock, Dr., 76. 

Leblond, A., Paris, 103, 106, 160, 178. 

Legroux, 345. 

Le Dieborder, Dr., Paris, 338. 

Leishman, Wm., Glasgow, 202, 207, 215, 

226, 228, 242, 255, 272, 291, 299, 305, 

327, 336/344. 
Lente, F. V., Saratoga, N. Y., 219. 
Lever, 211. 
Liebman, 100. 
Lisfranc, Dr., Paris, 51. 
Lister, Dr., London, 311. 
Locock, Charles, 53, 56, 75, 217. 
Long, W. H., Louisville, Ky., 240, 261. 
Loudon, Charles, 154. 
Ludlow, J. L., Philadelphia, 331. 
Lusk, W. T., New York, 237, 246. 
Lyman, G. H.', 70. 

Macan, A. V., London, 252. 
Macdonald, Angus, Edinburgh, 267. 
Maddon, T. M., London, 146, 147. 



;6 4 



INDEX OF AUTHORS. 



Maissonneuve, M., Paris, 165, 325. 
Mann, Dr., 262. 
Marsh, H., 79. 
Massmann, Dr., 269. 
Maury, Dr., New York, 244. 
McClintock, Dr., London, 140, 145, 252, 

344- 

McGuire, Hunter, Richmond, Va., 314. 
Meadows, Alfred, London, 68, 155, 156, 
203, 209, 243, 248, 249, 254, 274, 280. 
Meissner, 209. 

Miller, Hugh, Glasgow, 287, 288, 316. 
Milne-Edwards, Dr., 244. 
Milton, Dr., 185 

Mitchell, S. Weir, Philadelphia, 73. 
Moller, Dr., Vienna, 262. 
Morgan, Mr., Litchfield, Eng., 124. 
Morris, John, Baltimore, Md., 173. 
Morton, D , United States, 244. 
Muller, P., Berne, 212. 
Mulreany, Jos., England, 174. 
Munde, Paul, New York, 98. 
Murphy, P. J., Washington, 288. 
Mussy, N. G., 103. 

Napier, A. D. L., London, 251. 
Napheys, Geo. H., Philadelphia, 198. 
Neal, Richard, London, 182. 
Neftel, Wm. B. 5 New York, 161. 
Newman, T. J., Chicago, 111., 28. 
Newman, W., Fulbeck, England, 328. 
New York State Women's Hospital, 99. 
Neimeyer, Felix Von, Tubingen, "J2>- 
Nceggerath, E., New York, 232. 

O'Hara, Michael, Philadelphia, 347. 
Oppenheimer, L. S., Louisville, Ky., 70. 
Ore, D., Bordeaux, 238. 

Pajot, Prof., 102. 

Pallen, Montrose A., New York, 131, 182, 

229. 
Panas, M., Paris, 63. 
Parish, W. H., Philadelphia, 286. 
Parry, John S., Philadelphia, 228,313. 
Peaslee, E. R., New York, 31, 145, 178. 
Penrose, R. A. F., Philadelphia, 258, 260. 
Pereira, 43, 168. 
Peters, Dr., Prague, 180. 
Philadelphia Hospital, 96, 313. 
Phillips, C. D. F„ London, 43, 56, 79, 

169, 170, 217, 245, 269, 275, 287, 319, 

345- 
Piffard, H. G., New York, 179. 
Pinard, A., Paris, 225. 
Pintschovius, Dr., Ketzin, 40. 
Pitois, Prof., Rennes, 218. 
Playfair, L., London, 93, 103. 
Playfair, W. S , London, 200, 209, 218, 

219,220,221,227,228, 233, 238, 242, 

248. 250, 257, 264, 273, 279, 289, 293, 

303. 304, 3 IO > 343. 



Porter, F. T., Dublin, 42, 73. 
Powers, J. L., Reinbeck, Iowa, 318. 
Purple, S. S., New York, 347. 
Putnam, S., Montpelier, Vt., 271. 

Raciborski, 37. 

Recamier, Madame, 70, 102. 

Reamy, Thad. A., Cincinnati, O., 245. 

Reid, A. P., Montreal, 77. 

Reynolds, 211. 

Richardson, Dr., Tunbridge Wells, 329. 

Richardson, W. L., United States, 245. 

Richter, Carl, Berlin, 285. 

Ricord, 214. 

Ringer, Dr., London, 41, 66, 68, 185,217, 

238. 
Roberts, F. T., Manchester, 77, 112. 
Robinson, C. E., West Union, Iowa, 282. 
Rokitansky, jr., 209. 
Ronzier-Joly, 41. 
Rousset, Prof., 328. 
Routh, C. H. P., London, 146, 148, 327, 

3 2 8, 329. 333, 342. 
Russel, P. E., England, 232. 

Sale, E. P., Aberdeen, Miss., 103, 
Sawyer, E. W., Chicago, 111., 342. . 
Saxe, A. W., California, 140, 
Scanzoni, Prof., Germany, 106, 118, 163, 

178, 210. 
Scheel, 209. 

Schmidt and Urner, 117. 
Scholler, 209. 
Schroeder„ Karl, Erlangen, 98, 177, 181, 

204, 208, 215, 233, 253, 264, 305. 
Schucking, 281. 
Schultze, B. S., Jena, 116. 
Schnerr, Dr., 328. 
Scudder, 245. 

Sell, E. H. M., New York, 244. 
Simpson, A. R., Edinburgh, 69, 147, 287. 
Simpson, Sir Jas. Y., Edinburgh, 44, 67, 

121, 141, 147, 149, 178, 275, 324. 
Sims, J. Marion, New York, 124, 141, 

178, 216,219. 
Sireday, 37, 161. 
Skene, A.J. C, New York, 115, 187, 192, 

201. 
Skinner, 333. 

Sloan, S., Glasgow, 339, 344.. 
Smith, Albert H., Philadelphia, 134, 238, 

246, 249, 346. 
Smith, Q. C, California, 313, 329, 346. 
Smith, Tyler, London, 168,210,223, 229, 

248. 
Spiegelberg, Otto, Breslau, 268, 270. 
Stackler, 214. 

Stanislaus, Martin, Auvergne, 329. 
Stephenson, \V., London, 244. 
Stille, Alfred, Philadelphia, 41, 74, 213, 

331- 
Stokes, J. G.j Illinois, 212. 



INDEX OF AUTHORS. 



365 



Storer, H. R., Newport, R. I., 1S1. 
Stradwick, Dw, 256. 
Sussdorf, G. E., New York, 81, 120. 
Swayne, J. G., England, 205. 

Taliaferro, V. H., Atlanta, Ga., 97, 119. 
Tait, Lawson, Birmingham, Eng., 29, 47, 

84, 96, 103, 104, 120, 158, 166, 174, 183, 
Tanner, T. H., London, 42, 67, 170, 184, 

186, 220, 221, 225, 326. 
Tarnier, S., Paris, 45, 209, 211, 214, 224, 

227, 229. 
Thierry, Prof., Brussels, 76. 
Thomas, J. P. Kentucky, 162. 
Thompson, Ashburton, London, 314, 318. 
Thompson, PL, London, 149, 1S9. 
Thompson, Rezin, U. S., 162. 
Thomas, T. Gaillard, New York, 22, 31. 

35, 46, 60, 66, 70, 78, 95, 108, 115, 116, 
137, 149, 152, 219, 256, 263, 292. 

Tilt, Edward J., London, Eng., 26, 27, 30, 

36, 41, 42, 43, 55, 57, 61, 65, 66,^67, 69, 
70, 74, 78, 99, 102, 103, 116, 118, 119, 
122, 146, 147,148,154, 156, 158, 165, 
168, 170, 179, 182, 187, 190, 219, 220, 
287. 

Trask, Dr., London, 261. 

Traube-Rosenstein, 269. 

Travers, Dr., 291. 

Trelat, Prof., Paris, 164. 

Trenholm, E. PL, Montreal, Canada, 287. j 

Trousseau, Prof., Paris, 44. 

Tuke, Dr., London, 273. 

Turnbull, Laurence, Philadelphia, 155. 

Tye, Geo. A., Canada, 259. 



Yaraseau, 244. 

Veil, Dr., 335. 

\ elpeau, Prof., Paris, 144, 345. 

Vienna Hospitals, 347. 

Von Hecker, Prof., Munich, 260. 

Walker, J. \V. Indiana, 143. 
Wallace, Ellerslie, Philadelphia, 133. 
Walters, John, London, 259. 
Ward, O , Tennessee, 55. 
Warren, John S., New York, 193. 
Weber, F., St. Petersburg, 176. 
Wells, Spencer, London, 19, 147. 
West, Dr., London, 185, 186. 
White, H. B., Brooklyn, N. Y., 268. 
White, James P., Buffalo, N. Y., 100, 287. 
Wiglesworth, Arthur, Liverpool, England, 

243- 
Wilkins, W. W., New Hampshire, 100. 
Williams, John, London, 33, 54, 130. 
Williams, R , 113. 
Williams, Wynne, London, 148. 
Wilson, Ellwood, Philadelphia, 58. 
Wilson, Erasmus, London, 185, 339. 
Wilson, H. P.C., Baltimore, Md.,258, 261, 

287. 
Wdson, Dr., Glasgow, 343. 
Wilson, 345. 
Winckel, F., Rostock, Germany, 182, 251, 

267, 289, 299,301.303,304, 3i7,335>345- 
Windebrand, Dr., 262. 
Woodbury, Henry E., Washington, 53,101. 
Woodruff, Julian S., South Carolina, 53. 
Workman, J., Toronto, Canada, 68, 261. 
Wright, C. O., Cincinnati, Ohio, 185. 



Van De Warker, Ely, New York, 152, 221. Zweifel, Prof., Erlangen, 281. 



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of each other, while still wholly independent. 

PRICES. 

The regular price for the Compendium for one year (two numbers, 300 pages 
each, bound in paper,) is $2.50. 

A discount is allowed on the Reporter and Compendium when taken together, 
as follows : 

The Weekly Medical and Surgical Reporter, - • |5 00 

The Half- Yearly Compendium of Medical Science, - - 2 50 
The Reporter and Compendium, taken together, - - 7 00 
JS^ Payable in advance, direct to the publisher. 

A Table of Contents of a number of Half- Yearly Compendium will be sent on 
application to the publisher. 

A single copy will be sent for examination for One Dollar. 



"A number of ' Visitiny Lists 9 offer themselves as candidates 
for doctors' favor. We are decided in our opinion that 'Butler's 
Physician's Pocket Record/ issued by D. G. Brinton, is unri- 
valed in its excellence." — Louisville Medical News. 



THE PHYSICIAN'S 

DAILY POCKET RECORD, 

COMPRISING 

A Visiting List, Many Useful Memoranda, Tables, etc. 

I3y S. W. BUTLER 3Z. D. 

Fourteenth Year. New and Thoroughly Revised Stereotype Edition for 1880, with 

Metric Posological , Table, &c. 

Edited Annually, and Adapted for 35 or 70 Patients Daily. Strongly Bound 
in American Russia, "With Steel Spring Clasp. 

DDTPC /EDITION FOR 35 PATIENTS DAILY, - 
1 i\lL/i} — I EDITION FOR 70 PATIENTS DAILY, - 



51.50 
2.00 



The name of the purchaser will he stamped, in gilt letters, on the tuck, for ten cents extra. 



For this year (1880), this favorite Visiting List has been brought out, with 
many improvements. The popular arrangement of the ruling and blank forms has 
been continued, as well as the "perpetual almanac" feature. The latter gives this 
List the great advantage that it may be begun at any time during a year, and may 
be used, continuously, one full year from the first entry, and does not, like other 
Visiting Lists, become as useless as an old almanac at the close of the calendar year. 

The binding of the Pocket Record is in desirable red leather (American 
Russia) ; and instead of a tuck (which often tears), it has a steel spring clasp. 
exceedingly convenient in use. A pocket is provided in the cover, for carrying pre- 
scription blanks, etc. 

The contents of the new stereotype edition of the Pocket Record are as 
follow : 

1. A Perpetual Almanac, from 1861 to 191 7. 2. Explanation of the Metric 
System. 3. Posological Table, arranged in alphabetical order, giving the doses of 
medicine in both apothecaries' weight and the metric system. 6. Doses of medi- 
cine for Hypodermic Injection. 7. Doses for Inhalation. 8. Doses for Supposi- 
tories and Pessaries. 9. The Treatment of Emergencies, including Poisoning, 
Poisonous Bites and Wounds, Asphyxia and Drowning. 10. Table exhibiting the 
normal and abnormal qualities of urine, their significance and tests. 11. New 
Remedies and Recent Preparations in Pharmacy, described with doses and uses. 
12. Table of Signs. 13. Table for calculating period of Utero-Gestation. 14. Vis- 
iting List, Obstetric Record, Vaccination Record, Cash Record, Death Record, etc. 

Many physicians who have made use of this Record during the period it has 
been before the profession, have expressed themselves in the highest terms of its 
convenience and suitability for the purpose. It is sufficient to quote the opinion of 
the editor of the Louisville Medical JVews, given* above, and the following, lately 
received from Dr. L. C. Butler, ex-President of the Vermont State Medical 
Society : 

"After using the Physician's Daily Pocket Record for the past twelve years, 
I am still so well pleased with it that I would not change it for any one of the 
numerous works of the kind that have been published during that time. It is all the 
' Day Book' a physician needs. The new edition just issued is an improvement on 
the former, in the new and important matter introduced, greatly increasing its prac- 
tical value." 



THE MEDICAL REGISTER AND DIRECTORY 

OF THE UNITED STATES, 

SYSTEMATICALLY ARRANGED BY STATES. 

Comprising- Names, Post-office Address, Educational and Professional Statis- 
tics, of more than 60,000 Physicians, with Lists of Medical Societies, 
Colleges, Hospitals and other Medical Institutions, with Abstracts of the 
Medical Laws of each State, Notes of Mineral Springs, etc. 

By SAMUEL W. BUTLER, M. JD. 

Second Edition, Revised and Corrected. 
One Volume, large octavo, double columns, 874 pages. Price, Cloth, $5.50 ; Leather, $6.50. 



The Second Edition of this Important work has been prepared at great cost of 
time and money. The lists have been carefully revised by leading medical men in 
each State. Nearly ten thousand new names have been added, and numerous cor- 
rections made. 

J6@T The publishers will be glad to receive information of changes of location from 
physicians. 



A Biographical Dictionary of Contemporary 
American Physicians and Surgeons. 

SECOND EDITION. 

Edited by WM. B. ATKINSON, M. D., 

Permanent Secretary of the American Medical Association, and of the Pennsylvania State Medical 
Society ; Lecturer on Diseases of Children at the Jefferson Medical College, etc. 



One Volume, Royal Octavo, Double Columns, 780 Pages, on Fine, Tinted Paper. 



Price, in extra cloth, beveled edges, $5.00; in full leather, $6.00. 



This really monumental work, the fruit of enormous labor and outlay, contains 
the biographical sketches of more than twenty-eight hundred contemporary regular 
physicians of the United States, prepared from materials in most instances furnished 
by themselves, and hence entirely trustworthy. Indexes of names and places are 
appended. The effort has been made to embrace all who have visibly contributed 
to the advancement of medical science in all parts of the Union, and the volume 
presents a mass of most valuable historical, biographical and scientific material. 

fgsf A few copies of the First Edition, with nearly a hundred fine steel engrav- 
ings, for sale at $10.00 each. 



Operative Surgery and Surgical Anatomy. 

BY PROFESSOR CLAUDE BERNARD, 

Membre de l'lnstitut (Academie Francais et Academie des Sciences), and 

CH. HTJETTE (DE MONTARG-IS.) 

Illustrated by eighty-eight PLATES, Drawn from NATURE and Engraved on STEEL 

Translated from the French, and Edited, by 

ARTHUR TREHERNE NORTON, F. R. O. S., 

Lecturer on Surgery, St. Mary's Hospital, London, etc. 
In One Volume, 441 Pages, 88 full-page Steel Plates. Price, Cloth, $8.00 ; Full Leather, $9.00. 



This magnificent and classical work deserves the especial attention of the Ameri- 
can profession. The names of the authors are a guarantee of its excellence, and it 
can be claimed, without fear of contradiction, that the artistic finish and anatomical 
accuracy of the plates surpass any others which have been placed in the market. 

The remarkably low price at which it is offered renders it the cheapest, as well 
as the most perfect, work on Operative Surgery ever published in this country. 

The highest testimonials to its value have been given by the English and Ameri- 
can press. 

It covers the whole domain of surgery, embracing surgical gynaecology and 
orthopedics, as well as all the most approved general and special operations. 

The descriptions are full, clear and accurate, and will be found to be of the most 
satisfactory character to practical surgeons. 

The translator, Mr. Norton, has added abundant details of the many improve- 
ments in Operative Surgery which have been introduced since the publication of the 
French work, and where more than one operation may be performed, special refer- 
ence is made to that most approved by surgeons of the present day. He does not 
confine himself to a mere rehearsal of the steps of a procedure, but gives the surgical 
anatomy of the part, and the points of diagnosis, describes the instruments, and 
mentions the accidents which may follow. In this manner the work is rendered a 
standard treatise of great completeness and permanent value. In size it is a com- 
pact octavo, convenient for holding, and for this reason superior to the large atlases. 

The general contents of the work may be seen from the following summary : 

Plates I- VI. Minor Surgery, Arteriotomy, Torsion. 

" VII-XVII. Ligations of Arteries. 

XVIII-XXVII. Disarticulation. 
XXVIII-XXXIV. Amputations and Resections. 
XXXV-XLIII. Operations on the Eye and Ear. 
" XLIV-LVII. Hare-lip, Stammering, Nasal Polypi, Staph ylor- 

aphy, Extirpation of Goitre, Bronchotomy, 
etc. 
" LVIII-LXXI. Operations on the Abdomen, Hernia, Artificial 

Anus and Rectal Surgery. 
" LXXII-LXXX. Operations on the Penis, Scrotum and Bladder, 

Lithotomy, etc. 
LXXXI-LXXXVI. Operations on the Genital Organs of Women. 
" LXXXVII, LXXXVIII. Tenotomy, Club Foot, etc. 

Each one of the plates contains from two to ten figures, most carefully designed 
and engraved. 



NAPHEYS' 

THERAPEUTICS SERIES 



EDITED TO I88O. 



I. MODERN MEDICAL THERAPEUTICS. A Compendium of Recent 
Formulae and Specific Therapeutical directions from the practice of eminent contem- 
porary physicians, American and foreign. By Geo. H. Napheys, A. M., M. D. 

1 vol., 8vo„ pp. 607. Price, Cloth, $4.00; Sheep, $5.00. 

II. MODERN SURGICAL THERAPEUTICS. A Compendium of 
Current Formulae, Approved Dressings and Specific Methods for the treatment of 
Surgical Diseases and Physics. By Geo. H. Napheys, A. M., M. D. 

1 vol., 8vo„ pp. 608. Price, Cloth, $4.00; Sheep, $5.00. 

III. THERAPEUTICS OF GENJECOLOGY AND OBSTETRICS. 

Edited by Wm. B. Atkinson, M. D„ etc. 

1 vol., 8vo., pp. 366. Price, Cloth, $3.O0; Sheep, $3.50- 



Sold separately at the prices given, or the three volumes, in cloth, at one 
order, for $10.00 ; in sheep, at $12.00. 



The very great popularity which the first two of these works has achieved has 
led to the completion of the series on the same plan, by the addition of the third 
number, the Therapeutics of Gynaecology and Obstetrics, under the able editor- 
ship of Dr. Wm. B. Atkinson. It is not too much to say that there are no other 
works in the language of equal practical value to the working physician. Proof of 
this lies in the fact that since their first appearance the publisher has offered, in all 
cases where the books were ordered without previous examination, to take them back 
and refund the price if, on arrival, they were not satisfactory, and that, in not a 
single instance, has he been asked to do so. This offer is continued. 

THE MEDICAL THERAPEUTICS. 

The total number of authors quoted is 723, and the precise formulae given, 1124. 
Each disease is taken up and its treatment presented according to the latest and best 
authorities in Europe and this country. Many of the directions and formulas have 
never been published elsewhere. A "Resume of Remedies " follows each disease, 
showing all the drugs which have a well-merited reputation in the therapeutics of the 
complaint. Nor are the descriptions confined to drugs only, but every therapeutic 
resource in a disease is specified, including electricity, bathing, mineral waters, 
external applications, climate, diet, sanitation, etc., etc. Thus, in the Therapeutics 
of Diseases of the Respiratory Organs, we have : 



Grindelia, lobelia, caffea, etc., in asthma. Formulae for medicated cigarettes. 

Thirty pages are devoted to the treatment of acute and chronic bronchitis, 
coryza and catarrh. 

Hay asthma (rose cold) is thoroughly discussed. 

On Phthisis there are 25 pages, giving, besides the ordinary treatment from Da 
Costa, Williams, Flint, Walshe, etc., th'e hygienic rules of Aitken, Both's plan of cal- 
cification of the lungs, Churchill on hypophosphites, Dobell's pancreatic emulsion, 
Jaccoud's arsenical treatment, Maclaren's rules for sea voyaging, Yeo on antiseptic 
inhalations, etc. 

Special attention has been paid to New Re7?iedies, New Preparations, and the 
indigenous materia medica of the United States. 

THE SURGICAL THERAPEUTICS. 

The number of authors quoted is 418; the number of their prescriptions 
given, 1008. The special object of this work is to set forth the medical aspect of 
Surgery, to collect in one volume the Therapeutics of Surgery, the formulas and 
medical treatment of Surgical diseases of the most eminent surgeons. 

The following points from the chapters on " Wounds," will show the subjects 
treated : 

General and local anaesthetics, anaesthetic mixtures, anaesthesia of the larynx. 

Burow, Porcher and Wood's open treatment of wounds, Gamgee's anhydrous 
dressings, Guerin's raw cotton dressings, water dressings, Dolbeau's alcoholic dress- 
ings, Hewson's earth dressings, Lister's carbolated dressings, Spence's boracic acid 
dressings, Polli's sulphite dressings, etc. 

Bartholow's, Hyatt's and Holmes' methods with erysipelas. Dr. Garretson's 
specific combination. 

Hemorrhage : Richardson's styptic colloid, styptic lint, wool, cotton and col- 
lodion. Styptic mixtures of Pancoast, Pagliari, Martin, etc. Methods of torsion, 
and pressure, and cold. 

The immediate and later treatment of primary and second shock, by Brunton, 
Hood, Fothergill, Smith, Gross, Fuller, Holmes, etc. 

The use of physostigma, aconite, atropia, strychnia, etc., in tetanus. Wier 
Mitchell on traumatic paralysis and neuralgia. 

The latest views of the German surgeons, Esmarch, Stromeyer and Billroth, on 
gunshot wounds. 

The best remedies in hydrophobia. Halford's ammonia treatment of snake 
bites. 

Numerous applications for burns, scalds, frost bites, bed sores, carbuncles and 
boils. 

OPINIONS OF THE PRESS. 

From a very large number of lengthy and favorable reviews of this work we quote the 
following brief expressions : 

Boston Journal of Chemistry. " Contains the latest improvements in treatment." 
New York Medical Journal. "Of much value to the surgeon and general practitioner." 
New York Medical Record. " Invaluable to every practicing physician." 
Buffalo Medical and Surgical Journal. " Wisely made up from the best and most 
recent authorities." 

Philadelphia Medical and Surgical Reporter. " A pre-eminently useful work." 
Philadelphia Medical Times. " All that is in the book is good." 

Maryland Medical Journal. " Most valuable additions to medical and surgical litera- 
ture." 

Cincinnati Medical News. "It affords the reader an intelligent idea of the combining 
of remedies for the fulfilling of definite indications." 

Cincinnati La7icet and Observer. " Two volumes, equally valuable to the general 
practitioner." 

Cincinnati Clinic. " The thoroughness of this collection seems quite surprising." 
Detroit Laticet. " The author has attained his aim with more than usual success." 
St. Lota's Clinical Record. " A unique book ; it shows vast labor on the part of the 
author. ' ' 

Louisville American Practitioner. " Cannot fail to help almost any practitioner." 
The Dental Cosmos. "A valuable addition to any medical library." 



The Therapeutics of Gynecology and Obstetrics. 

EDITED BY WNI. B. ATKINSON, A. M., M. D., 

Lecturer on Diseases of Children, at the Jefferson Medical Cotlege ; Physician to the Department of 

Obstetrics and Diseases of Children, Howard Hospital, Philadelphia; Permanent 

Secretary of the American Medical Association, etc. 

1 vol., 8vo., 366 pp. Price, Cloth, $3.00; Full Leather, $3.50. 



This new work, just issued, presents a condensed, carefully weighed and accu- 
rately presented review and estimate of the therapeutical resources of the gynaeco- 
logist and obstetrician. The remarkable activity which has characterized this 
specialty of late years, the numerous monographs and journals devoted to it, have 
vastly increased its materia medica and forms of therapeutics ; and a summary of 
these discoveries and improvements cannot fail to be welcome. The general plan 
adopted is similar to that so deservedly popular in "Napheys' Modern Therapeutics." 
The most recent publication of the European press, and all the special journals of 
both continents have been laid under contribution. 

It is divided into two parts, embracing the principal diagnostic features and the 
treatment of leading practitioners in diseases of women and obstetric complications. 
The contents of the two parts are as follow : 

PART L— GYNAECOLOGICAL THERAPEUTICS. 

CHAPTER I. 

Diseases of the Ovaries, Disorders of Menstruation, and General Diseases. 

Synopsis of Diagnostic Points — Ovaritis, Acute and Chronic (Ovarian Neuralgia, 
etc.) — Ovarian Tumors — Amenorrhoea — Dysmenorrhea — Menorrhagia and Me- ■ 
trorrhagia — Hysteria — Chlorosis and Anaemia — The Change of Life, or Climac- 
teric Epoch. 

CHAPTER II. 
Diseases of the Uterus and its Annexes. 

Synopsis of Diagnostic Points — Metritis (Non-puerperal Endo-Peri and Parametritis, 
Uterine Catarrh, etc.) — Cervicitis (Ulcerations and Granulations of the Os, 
etc.)— Displacements — Non-malignant Growths (Polypi, Fibroids, etc.) — Malig- 
nant Growths — Sterility and Anaphrodisia — Nymphomania. 

CHAPTER III. 

Diseases of the Vagina, Urethra and Bladder. 
Synopsis of Diagnostic Points — Vaginitis, Acute and Chronic, Non-specific — Vagin- 
itis, Specific, Gonorrhceal — Vaginismus and Dyspareunia — Vaginal Growths — 
Pruritus Vulvae and Vulvitis — Cystitis, Acute and Chronic — Urethritis — Urinary 
Disorders — Irritable Bladder, Dysuria, Polyuria, Ischuria, Enuresis, Vesical 
Tenesmus, etc. 

PART II.— OBSTETRICAL THERAPEUTICS. 
CHAPTER I. 

The Disorders of Pregnancy. 
The Hygiene of the Puerperal State — Abortion and Premature Labor (Prevention 
and Induction) — Vomiting and Nausea of Pregnancy — Sympathetic Nervous 
Disorders (Palpitation, Syncope, Neuralgia, Pruritus, etc.) — Digestive Derange- 
ments of Pregnancy (Dyspepsia, Constipation, Diarrhoea, Hemorrhoids, Albu- 
minuria). 

CHAPTER II. 
Complications, Disorders, and Sequelae of Parturition. 
Anaesthetics in Labor — Tedious Labor (Rigid Os, Uterine Atony, etc.) — After- 
Pains— Puerperal Hemorrhage — Puerperal Eclampsia — Puerperal Mania— Puer- 
peral Septicemia — Thrombosis and Embolism — Shock — Pelvic Cellulitis and 
Peritonitis (Puerperal Phlebitis and Metritis) — Phlegmasia Dolens — Milk 
Fever, Puerperal Convalescence. 

CHAPTER III. 
Diseases of the Mammary Glands and of Lactation. 
Mammitis, Inflammation of the Breasts — Mammary Tumors — Mammary Neuralgia, 
Mastodynia — Galactorrhea — Agalactia and Oligolactia — Diseases of the Nipple. 



10 
A MANUAL OF 



EXAMINATION OF THE EYES. 



A COURSE OF LECTURES DELIVERED AT THE " ECOLE PRATIQUE," 
J3y X>r». JE. LANDOLT, 

Directeur-Adjoint of the Ophthalmological Laboratory at the Sorbonne, Paris. 
TRANSLATED BY 

SWAN M. BURNETT, M . D., 

Lecturer on Ophthalmology and Otology in the Medical Department of the University of Georgetown, 
and Ophthalmic Surgeon to the Central Dispensary, Washington, D. C. 

REVISED AND ENLARGED BY THE AUTHOR. 

1 vol., 8vo, pp. 307. With numerous Illustrations and a large Chart. Price, cloth, $3.00. 



This entirely new and valuable work has received the very highest testimonials, 
both in Europe and America. We quote the following from the American press : — 

" Dr. Landolt is one of the clearest writers of the day. This little manual will 
certainly, in its English dress, prove of very great value to students of ophthalmology, 
and to those general practitioners who have a taste for examining eyes, for it gives 
instructions on very complicated subjects in a very terse and clear way. It would 
hardly seem possible to get so great an amount of matter into so small a space as Dr. 
Landolt has done in this book." — Cincinnati Lancet and Clinic, April, i8jg. 

"The author of this excellent work has succeeded in simplifying the subjects 
which he has put before the profession to such an extent as to render his book far 
superior to anything of the kind that has yet appeared in print. 

" The plain, easy, and yet scientific manner in which Dr. Landolt presents the 
various subjects contained in his work is emphatically suggestive of an honest, earn- 
est, astute student, and shows at once that the contents of the volume are the result 
of the work of a careful and conscientious observer. The book has no scent of 
scissors or paste pot. Although reference is made to other authors, I believe there 
is not a single quotation in it. 

"The twenty-second lecture is upon examination of the fundus in detail. The 
special feature of this lecture is the manner in which the optic nerve and its sheaths 
are described. Nowhere can there be found a cut which so nearly represents the true 
nature and relations of the optic nerve and its sheaths. I believe that it is unique ; 
at all events, it far excels all other efforts in this direction. 

"The book is one that can be recommended to the doctor and student, with the 
assurance that it will meet every demand. May the author live long and continue 
his work in the same direction, is the wish of the reviewer.'' — Louisville Medical 
News, July, 1879. 

" This book is a most admirable and complete expose of our means and methods 
of making a thorough scientific examination of the human eye. Written in the 
attractive, easy style of lectures, unencumbered by unnecessary mathematical formu- 
las, printed on heavy paper and in large and clear type, translated with care and skill 
into fluent English, this book will contribute largely toward awakening greater inter- 
est for ophthalmology among the reading members of our profession." — Chicago 
Medical Journal and Examiner, August, iSjp. 



11 
CONSPECTUS 

OF 



COMPRISING 

The Vegetable and Animal Drugs, their Physical Character, Geographies 
Origin, Classification, Constituents, Doses, Adulterations, &c, 

1 Vol., 8vo., pp. 220, with Folding Tables. Price, in Cloth, by mail, post paid, $2.0( 



PLAN OF THE WORK. 

The Chart. — In the space of seventeen of the first pages is found the whol 
Materia Medica, arranged according to Natural Orders. Every drug is mentioned 
Opposite the column of drugs are arranged in a tabular manner all the followin 
points concerning it : Officinal Name, Botanical Name, Common Name, Habitat 
Part Used, Constituents, Medical Properties, Dose, Officinal Preparations ; makin 
in all io columns, supplying the place of the cumbrous broadsides heretofore in us 
for this purpose. 

Geographical Grouping of Drugs. — This comprises three pages, giving the charac 
teristic drugs derived from different sections of the world. 

Botany. — This subject is treated as an introduction to other and more voluminou 
treatises, under the following heads : The Cell, Cell Modification, Tissues, Ceil De 
velopment, Contents of Cells; The Stem, Subterranean Stems, Leaves, Flowen 
Fruits and Seeds. The arrangement and display of the material is such that it wii 
rather fascinate than tire the student. The botanical terms are, in every case, mad 
clear by definition, so that they are readily comprehended. 

Natural Orders. — This chapter opens with a general treatise upon the subject 
followed by a tabular arrangement of the principal natural orders. The most promi 
nent characteristic of these and their sub-orders are brought out unencumbered wit 
such detail as a manual of botany would give, thus furnishing points to refresh th 
memory, and giving an appropriate outline for the beginner. 

Drugs — Their Characteristics, Constituents, &c, &c. — This subject occupies th 
body of the work. In one hundred and fifty pages are embraced not only all th 
drugs which are officinal in the U. S. P., but others of any prominence, especiall 
those recently brought into favor. They are arranged according to their physica 
characteristics, thus bringing together the various parts of the plants, furnishin 
groups as follows : Roots, Rhizomes, Tubers, Bulbs, Stems, Woods, Barks, Leave 
and Leaflets, Herbs, Flowers and Parts of Flowers, Fruits and Parts of Fruits, Seeds 
Cellular Drugs not easily recognized as parts of plants, Drugs destitute of Cellula 
Tissues, &c, closing with a chapter upon Animal Drugs. 

Tables. — Two tables complete the work ; one of the Alkaloids and one of th 
Antidotes and Incompatibles. 

It may be said of the former, it contains all of the officinal and most of th 
prominent alkaloids, and gives in a tabular form many interesting points concernin 
them not heretofore mentioned. 



12 

DIFFERENTIAL DIAGNOSIS: 

A MANUAL OF THE COMPARATIVE SEMEIOLOGY OF THE MORE 

IMPORTANT DISEASES, 
By F. r>E HAVILLAND "BCAJLIL,, M. 1>. 9 

Assistant Physician to the Westminster Hospital, London. 
American Edition, with Extensive Additions. 

One Volume, 8vo., pp. 205. Printed on handsome tinted paper; bound in English pebbled cloth, 

with beveled boards. Price $2.00. 



Dr. Hall's work has received the highest encomiums from the English medical 
press, for its lucid arrangement, completeness and accuracy. He himself is known 
in London as a practitioner of great skill, and an unusually successful medical 
teacher. 

Most of the diseases which may be confounded are presented in comparative 
tables, setting forth their distinctive characteristics in the clearest possible light, and 
thus greatly facilitating their prompt diagnosis. 

OPINIONS OF THE PRESS. 

The British Medical Journal says: "This is not of the type of books brought 
out by ' grinders.' The tables it contains are invaluable aids by the bedside, enabling 
the student and practitioner readily to compare signs met with in disease." 

The North Carolina Medical Journal says : " The tabular method of comparing 
symptoms is well utilized. Very many valuable diagnostic formulae are brought 
together." 

The Atlanta Medical Journal says : " The comparative symptoms are given in 
a very satisfactory manner. The work will afford valuable aid to practitioners." 

The Boston Medical and Surgical Journal, Marc,h 6th, 1877, says : " The physi- 
cal signs and the symptoms of the various affections are arranged in tabular form for 
convenient reference, and the facility thus afforded for comparison and discrimination 
enables this manual to supply a want often experienced in more elaborate treatises." 

The New Orleans Medical and Surgical Journal says: "The plan of the work 
we regard as highly commendable for its convenience of reference and the precision 
of which it is capable." 

~THE DISEASES OF LIVE STOCK, 

Including Horses, Cattle, Sheep and Swine. 

Containing a description of all the usual diseases to which these a?iimals are liable, and the 

most successful treatmejit of American, English and European Veterinarians. 

By LLOYD V. TELLOR, M. D. 1 vol., 8vo., pp. 474. Price, Cloth, $2.50. 



This work is divided into four parts, as follows : I. General Principles of Veteri- 
nary Medicine. II. Diseases of the Horse. III. Diseases of Cattle, Sheep and 
Swine. IV. Hygiene and Medicines. 

The author of this work is a regular physician, whose practice in the country 
has led him to study the diseases of domestic animals, and we can point to it as the 
first and only book, by an American physician, which describes, with scientific 
accuracy, and yet in plain language, these common and important maladies. 



13 

OBSTETRIC PROCEDURE. 

BY WILLIAM B. ATKINSON, A. M., M.D., 

Lecturer on Diseases of Children, at the Jefferson Medical College. Physician to the 

Department of Obstetrics and Diseases of Children, Howard 

Hospital, Philadelphia, Penna. 



SECOND EDITION. ENTIRELY RE-WRITTEN AND ENLARGED. 

12mo., CLOTH. PRICJ], $1.00. 



"The charmingly informal style of the author renders the reading of the mono- 
graph a positive pleasure. Conscientiously we feel that we are working in the inter- 
ests of both physician and patient when we say to all who do not own it now, order 
at once a copy of these Hints for your own use." — The Detroit Lancet, July, 1879. 

" The author, a teacher of experience, treats his subjects in a way to make it 
especially useful to the student, but not to the student alone." — The Richmond and 
Louisville Medical Journal, June, 1879. 

" Dr. Atkinson fully appreciates the vast importance of the obstetric art in both 
its immediate and remote effects on mothers and children, as well as the reputation 
of the physician, and, in this interesting little work, gives valuable hints, which are 
intended to guide us in the management of women before, during and after the ter- 
mination of labor." — Canada Journal of Medical Science, July, 1879. 

"The many valuable points cited, the practical manner in which they are 
stated, together with the sound views of practice enunciated, make this little mono- 
graph truly valuable." — The Southern Practitioner, January, 1879. 

"It is the gist of the obstetric art in convenient form, and will serve to refresh 
the practitioner's mind in any case pertaining thereto." — Maryland Medical Jour- 
nal, June, 1879. 

ON COUGHS, 

CONSUMPTION, AND DIET IN DISEASE. 

By HORACE DOBELL, M. D., F. B. M. 0. S., 

Consulting Physician to the Royal Hospital for Diseases of the Chest, London, etc. 
8vo., Cloth. Illustrated. Tinted Paper. Pages, 222. Price, $2.00. 



This work consists of three parts. Part I. treats of the Diagnosis of Bronchial 
and Pulmonary Diseases. Part II., which makes the bulk of the book, is taken up 
with the all-important subject of the treatment of pulmonary affections. Part III., 
which is the shortest, is a succinct, condensed exposition of the principles and rules 
of dietetics in disease. 

As an authority on the above subjects, Dr. Dobell ranks second to none in Great 
Britain. His experience has been immense, and the peculiarly practical tone of his 
mind renders his writings unusually instructive to the practicing physician. 

From the New York Medical Record : " The book is well printed, and contains 
many valuable suggestions." 

From the Virginia Medical Monthly : " We find in this work a great deal to 
approve, and but little to criticise." 

From the Pacific Medical and Surgical Journal : "Dr. Dobell brings much 
new light to this important subject. His work will be pursued with great satisfac- 
tion. It is a very handsomely printed volume." 

From the Sanitarian : "A good book on these subjects has a wide application, 
and such is the one now before us. Dr. Dobell has long been known as one of the 
most accomplished physicians of London." 



14 



LESSONS IN GYNECOLOGY. 

By WM. GOODELL, A. M., M. D., 

Professor of Clinical Gynaecology in the University of Penna. 

WITH NUMEROUS ILLUSTRATIONS. 
SECOND EDITION. 

THOROUGHLY REVISED AND CONSIDERABLY ENLARGED. 

One Volume 8vo. Price-Clotli, $4,; Sheep, $4.50. 



The Second Edition of this able work was demanded within three months 
from the publication of the first. The author has, however, taken the time to give 
it a very careful revision, and has added a large amount of new and unpublished 
material. The following table of contents will indicate its scope : 
Lesson I. Gynaecological Instruments. 

Modes of Examination. 

Caruncle, and other Affections of the Female Urethra. 

Vesical Diseases of Women. 

Fistulae of the Female Genital Organs. 

Closure of the Vulva for incurable Vesico-vaginal Fistulas — Tumors 
of the Vulva. 

Some Affections of the Vulva and Surrounding Parts. 

On the Causes, Prevention and the Cure of Lacerations of the Female 
Perineum ; the Primary Operation. 

Secondary operation for Laceration of the Female Perineum. 

Metritis and Endometritis, Acute and Chronic. 

Local and Constitutional Treatment for Chronic Metritis and Endo- 
metritis. 

Retroversions and Retroflexions of the Womb. 

Anteversions and Anteflexions of the Womb. 

Dilatation of Cervical Canal ; Rapid Dilatation ; Tents. 

On the Use of the Closed Lever Pessary, and of the Intrauterine 
Stem Pessary. 

Different kinds of Pessaries ; Abdominal Supporters. 

Prolapse of the Womb; Prolapse from Simple Descent; Prolapse 
from Hypertrophic Elongation of the Infra-vaginal Portion of 
Cervix. 

Prolapse of the Womb from Hypertrophic Elongation of the Supra- 
vaginal Portion of the Cervix. 

Laceration of the Cervix Uteri. 

Cancer of the Womb. 

Vegetations of the Endometrium. 

Polypus of the Womb. 

Fibroid Tumors of the Womb. 

Treatment of Fibroid Tumors of the Womb. 

Ovaritis and Prolapse of the Ovaries. 

Spaying for Fibroid Tumors, and for other Diseases of the Womb. 

Ovarian Cyst ; its Diagnosis, and its Treatment by Tapping, by 
Injections of Iodine, and by Drainage. 

Ovariotomy by Abdominal Section. 

Vaginal Ovariotomy. 

Nerve-Tire and Womb-Ills, or the Relation which the Nerves Bear 
to the Diseases of Women. 

The Prevention of Uterine Disorders. 

The Sexual Relations as Causes of Uterine Disorders. 

The Relation which Faulty Closet Accommodations Bear to the Dis- 
eases of Women. 



II. 
III. 
IV. 

V. 
VI. 

VII. 
VIII. 

IX. 

X. 

XI. 

• 
XII. 

XIII. 

XIV. 
XV. 

XVI. 
XVII. 



XVIII. 

XIX. 

XX. 

XXI. 

XXII. 

XXIII. 

XXIV. 

XXV. 

XXVI. 

XXVII. 

XXVIII. 

XXIX. 

XXX. 

XXXI. 
XXXII. 

XXXIII. 



15 

A Treatise on Hernia, 

With a New Process for its Radical Cure, and Original Contributions to 
Operative Surgery, and New Surgical Instruments. 

BY GREENSVILLE DOWELL, M. D., 

Professor of Surgery in Texas Medical College; Late Professor of Surgery in Gal- 
veston Medical College; Member of the American Medical 
Association, etc., etc. 

One Volume, large 8vo., 76 Illustrations, 6 Full-Page Plates. Price, Cloth, $2. 



BY THE SAME AUTHOR. 

Yellow Fever and ilalarial Diseases. 

Embracing a History of the Epidemics of Yellow Fever in Texas ; New Views 
on its Diagnosis, Treatment, Propagation and Control ; Descriptions of Dengue, 
Malarial Fever, Jaundice, the Spleen and its diseases, and Diarrhoea Hemorrhagica. 

BY GREENSVILLE DOWELL, M. D. 

Cloth, 8vo., with Map and Two Chromo-Lithographs. Price, $2.50- 

The long experience of Dr. Dowell in the Diseases of which this work treats, 
constitutes him one of the most competent living authorities on the subject. He 
has treated many hundred cases of yellow fever, and claims to be able, b>* the plan 
he lays down in detail, to reduce the mortality in that disease to five per cent. 



Aids to Botany. 

BY C. E. A. SEMPLE, M. D. 

i2mo., paper, pp. 56. Price, 30 cents. 

One of the popular series of aid-books for students ; favorites in England. 



Aids to Anatomy. 

BY GEORGE BROWN, M. R. C. S., L. S. A., 

Late Demonstrator of Anatomy at Westminster Hospital Medical School, etc. 

12mo., pp. 64. Paper. Price, 30 cents. 

A cheap, accurate and convenient summary of anatomy for students. 



The Anatomy and Histology of the 
Human Eye. 

BY A. METZ, M. D., 

Professor of Ophthalmology in Charity Hospital Medical College, Cleveland. 

8vo., pp. 184, with 75 Wood Cuts. Price, Cloth, $2-00. 

A very carefully prepared, clear and distinct presentation of the anatomy of the 
eye, by a competent hand. 

" Cannot fail to be of great value to the general practitioner, as well as to the 
student of ophthalmology." — Boston Medical and Surgical Journal. 
"An excellent text-book." — Chicago Medical Examiner. 



